From the Guidelines
Iron overdose is a medical emergency that can lead to severe morbidity and mortality, and immediate treatment is crucial to prevent long-term complications and death. The effects of iron overdose can be devastating, and it is essential to recognize the signs and symptoms of iron toxicity, which can occur in stages, including gastrointestinal irritation, apparent recovery, metabolic acidosis and shock, and finally liver damage 1. According to a study published in 2016, iron overload in dialysis patients can silently increase the burden of complications, leading to accelerated morbidity and mortality in this population 2.
Key Findings
- Iron overdose can cause severe gastrointestinal irritation, metabolic acidosis, and shock, leading to liver damage and even death 1.
- Iron overload in dialysis patients can increase the risk of cardiovascular events and mortality, with high hepcidin-25 levels linked to fatal and non-fatal cardiovascular events 2.
- Oxidative stress, provoked by IV iron infusions and iron overload, can adversely affect the vascular bed and act as a 'second hit' 2.
- Iron overload can also affect several lineages of immune cells, leading to an increased risk of infection, and may affect glucose metabolism 2.
Treatment and Prevention
- Treatment of iron overdose typically involves gastric lavage, whole bowel irrigation, and administration of deferoxamine, an iron chelator, at 15 mg/kg/hour IV for severe cases 1.
- Supportive care includes managing fluid balance, correcting metabolic acidosis, and treating organ damage 1.
- Prevention involves keeping iron supplements in childproof containers and out of reach of children, as iron poisoning is a leading cause of fatal medication overdose in children under six 1.
Recommendations
- It is crucial to monitor iron levels closely in dialysis patients and adjust IV iron doses accordingly to prevent iron overload and its associated complications 2.
- Healthcare providers should be aware of the potential risks of iron overdose and take prompt action to treat and prevent it 1, 2.
From the FDA Drug Label
Adult respiratory distress syndrome, also reported in children, has been described following treatment with excessively high intravenous doses of deferoxamine mesylate in patients with acute iron intoxication or thalassemia.
The effects of iron overdose (iron poisoning) include adult respiratory distress syndrome. This condition has been reported in patients with acute iron intoxication who received high doses of deferoxamine mesylate 3.
- Key effects: Adult respiratory distress syndrome
- Population affected: Patients with acute iron intoxication or thalassemia
- Dose relationship: Associated with high intravenous doses of deferoxamine mesylate
From the Research
Effects of Iron Overdose
The effects of iron overdose, also known as iron poisoning, can be severe and potentially life-threatening. According to the studies, the effects of iron overdose include:
- Gastrointestinal symptoms such as nausea, vomiting, and diarrhea 4, 5
- Neurologic signs of toxicity, including coma and seizures 4, 5
- Severe anion gap metabolic acidosis 4
- Cardiovascular effects, including hypovolemic and cardiogenic shock 6
- Hepatic effects, including liver failure 6
- Coagulopathy and adult respiratory distress syndrome 6
- Metabolic effects, including hyperglycemia and hypoglycemia 5, 7
Severity of Iron Overdose
The severity of iron overdose depends on the amount of iron ingested, with doses above 60 mg/kg considered potentially serious 5. The studies report cases of severe iron intoxication with serum iron concentrations ranging from 134 micrograms/dL to 16,706 micrograms/dL 4, 5, 6.
Treatment of Iron Overdose
Treatment of iron overdose typically involves supportive care, gastrointestinal decontamination, and chelation therapy with deferoxamine 4, 5, 6. In some cases, hemodialysis may be necessary to decrease serum iron concentration and improve clinical status 4. The studies suggest that early recognition and treatment of iron overdose are crucial for a better outcome and to prevent morbidity and mortality 4, 5.