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Toxicity, Iron (Overview)

eMedicine Emergency Medicine, 2014

Introduction Background Iron overdose has been one of the leading causes of death caused by toxicological agents in children younger than 6 years.
Patients with anemias that require frequent blood transfusions also are at risk for developing chronic iron toxicity.
It acts on the mucosal tissues and manifests as hematemesis and diarrhea; patients may become hypovolemic because of fluid and blood loss.
Cellular toxicity: The absorption of excessive quantities of ingested iron results in systemic iron toxicity.
Severe overdose causes impaired oxidative phosphorylation and mitochondrial dysfunction, which can result in cellular death.
The liver is one of the organs most affected by iron toxicity, but other organs such as the heart, kidneys, lungs, and the hematologic systems also may be impaired.
Individuals demonstrate signs of GI toxicity with ingestions of more than 20 mg/kg, but less than or equal to 40 mg/kg.
Mortality/Morbidity Iron poisoning may result in mortality or short-term and long-term morbidity.
Age Iron overdose is one of the leading causes of fatality from toxicological agents in children younger than 6 years.
Clinical History Iron ingestions with GI symptoms such as vomiting and diarrhea (especially hemorrhagic) Hemorrhagic gastroenteritis, even in the absence of ingestion Hyperglycemia with metabolic acidosis during or following episodes of abdominal pain and gastroenteritis Physical Iron poisoning is often classified into 4 distinct stages.
Understanding the course of poisoning is important, especially the second (recovery) stage, which may lure the physician into a false sense of security and result in premature and inappropriate discharge of a patient.