From the FDA Drug Label
OVERDOSAGE Acute Toxicity ... Signs and Symptoms Inadvertent administration of an overdose or inadvertent intravenous bolus administration/rapid intravenous infusion may be associated with hypotension, tachycardia and gastrointestinal disturbances; acute but transient loss of vision, aphasia, agitation, headache, nausea, pallor, CNS depression including coma, bradycardia and acute renal failure have been reported Acute respiratory distress syndrome has been reported following treatment with excessively high intravenous doses of deferoxamine mesylate in patients with acute iron intoxication and in patients with thalassemia.
In the event of an iron overdose, look for signs and symptoms such as:
- Hypotension
- Tachycardia
- Gastrointestinal disturbances
- Acute but transient loss of vision
- Aphasia
- Agitation
- Headache
- Nausea
- Pallor
- CNS depression including coma
- Bradycardia
- Acute renal failure
- Acute respiratory distress syndrome 1
From the Research
In an iron overdose, look for symptoms that develop in stages, including nausea, vomiting, abdominal pain, diarrhea, and sometimes bloody stools, and prioritize immediate medical attention to prevent life-threatening complications, as evidenced by studies such as 2 and 3.
Key Symptoms to Look for:
- Nausea, vomiting, abdominal pain, diarrhea, and sometimes bloody stools within 6 hours
- Temporary improvement in the second stage (6-24 hours)
- Systemic toxicity with metabolic acidosis, shock, liver failure, coagulopathy, and renal failure in the third stage (12-48 hours)
- Hepatic necrosis and possible death in the fourth stage (2-5 days)
- Gastrointestinal scarring and pyloric stenosis in the fifth stage (2-6 weeks)
Laboratory Findings:
- Elevated serum iron levels (>300-500 μg/dL indicates significant toxicity)
- Metabolic acidosis
- Leukocytosis
- Hyperglycemia
- Coagulopathy
Treatment:
- Gastrointestinal decontamination
- Deferoxamine chelation therapy (15 mg/kg/hr IV for severe cases)
- Supportive care
- Abdominal X-rays may show radiopaque iron tablets
Important Considerations:
- Immediate medical attention is crucial as iron poisoning can rapidly progress to life-threatening complications
- The most dangerous period is 12-48 hours post-ingestion when metabolic acidosis and shock can develop, as highlighted in 3
- Studies such as 2 provide evidence-based guidelines for the management of iron ingestions, including the use of deferoxamine and supportive care.