In the 2005 edition of "Modern Nutrition in Health and Disease," director of the U.S. Department of Agriculture's Jean B. Mayer Nutrition Research Laboratory, Richard J. Wood, Ph.D. says that acute iron toxicity represents the most common cause of accidental poisoning deaths in U.S. children under the age of six. According to Wood, toxicity usually occurs at doses between 45 and 130 mg per pound of body weight. To prevent acute iron toxicity, take only the dose and type of iron your doctor recommends. Always keep all medications and supplements, including iron, out of reach of children and adults with cognitive impairments, such as dementia.
Symptoms
Symptoms of acute iron toxicity include difficulty breathing due to buildup of fluid in the lungs -- also known as pulmonary edema, chest pain, nausea, vomiting, diarrhea, black or bloody stools, metallic taste in the mouth, fast or weak heart beat, dizziness, fever, chills, seizures, headaches, drowsiness, pale skin, flushing or blue lips and fingernails. Some patients may develop coma or shock.
Time Frame
Depending on the dose and type of iron supplement, symptoms may appear as soon as 30 to 60 minutes after ingestion. With lower doses or extended-release formulations, they may take longer. Sometimes, symptoms seem to resolve within a few hours, only to reappear the following day. If you suspect acute iron toxicity, call your doctor or poison control at 1-800-222-1222 immediately. For severe or life-threatening symptoms, call 911 or the emergency department of your local hospital, if you are in an area where 911 is not available. Never attempt to transport the patient yourself, unless you are instructed to do so by emergency services personnel.
Diagnosis
Diagnosing acute iron toxicity is difficult because the affected person is often unable -- in the case of accidental overdose -- or unwilling -- in the case of intentional overdose -- to provide critical information. An x-ray will confirm the presence of abnormal amounts of iron in the gastrointestinal tract. Blood tests provide information about how much iron has already been absorbed. You can assist emergency room staff by providing information about the affected person's age, weight, other health problems, the name and dose of the product that was ingested, when it was ingested and how much was ingested.
Treatment
If the iron supplement remains in the stomach, your doctor may insert a tube down the patient's throat and attempt to wash or suction the medication out, a procedure call gastric lavage. If gastric lavage fails or if the pills have passed into the small intestine, a gastroenterologist or surgeon may attempt to retrieve them using a device called an endoscope. Most patients also require drugs that bind, or "chelate," iron and cause it to be eliminated in the urine. Other care depends on the specific symptoms and the circumstances that led to the ingestion.
Complications
Without timely treatment, shock and coma due to acute iron toxicity may result in rapid death. Even with timely treatment, death may still occur, especially if other drugs or supplements are involved. MedlinePlus says you have a "good chance" of recovery if you remain asymptomatic after 48 hours. Patients who do not may require long-term treatment for liver, heart or brain damage.
References
- "Modern Nutrition in Health and Disease, 10th Edition;" Maurice E. Shils, M.D., D.Sc. et al.; 2005
- MedlinePlus: Iron Overdose
- MayoClinic.com: Iron Supplement
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