IV Iron Sucrose Dosing for a 56 kg Teenager
For a 56 kg teenager with iron deficiency anemia, administer iron sucrose 200 mg IV per dose, given 2-3 times weekly (on alternate days), with a total cumulative dose of 600-1200 mg depending on severity of anemia and calculated iron deficit. 1, 2
Specific Dosing Protocol
Single Dose Administration
- Maximum single dose: 200 mg 1, 3
- Administer as slow IV push over 2-5 minutes OR diluted in 100 mL of 0.9% normal saline infused over 10-30 minutes 3
- Maximum weekly dose: 500 mg 3
Frequency and Total Dose
- Give infusions on alternate days, up to 3 times per week 2
- Typical number of infusions: 2-6 doses (median 3 doses) 2
- Total cumulative dose range: 400-1200 mg based on severity 2
- For this 56 kg patient, a reasonable starting total is 600-800 mg (3-4 doses of 200 mg each) 2
Pediatric Safety Evidence
Iron sucrose is well-established as the safest IV iron preparation in children, despite lack of formal European approval for pediatric use 1:
- In 232 children receiving 1,624 total doses, very few serious adverse reactions occurred 1
- A randomized study of 145 children/adolescents using doses of 0.5-2 mg/kg showed no anaphylactic reactions 1
- Iron sucrose is FDA-approved in the USA for children ≥2 years of age 1
- Real-world pediatric data shows hemoglobin rising from 7.6±2.38 g/dL to 12.4±0.64 g/dL within 31-42 days 2
Administration Safety Protocol
Pre-Administration Requirements
- No test dose required for iron sucrose (unlike iron dextran) 3
- However, consider 25 mg test dose over 5 minutes if history of IV iron sensitivities or multiple drug allergies 3
- Ensure resuscitation equipment, IV epinephrine, diphenhydramine, and trained personnel immediately available 3
Monitoring During Infusion
- Start infusion slowly for first 5 minutes to assess for reactions 3
- Monitor vital signs during and after infusion 3
- Observe patient for 15-60 minutes post-administration 3
Absolute Contraindications
- Active bacteremia - withhold therapy 3
- Chronic infection alone is NOT an absolute contraindication if risk/benefit favors treatment 1, 3
Expected Adverse Effects
Common (Generally Mild)
- Hypotension, nausea, vomiting, diarrhea 3
- Injection site reactions 2
- Transient taste perversion 2
- Overall hypersensitivity reaction rate: approximately 0.5% 1, 3
Serious (Rare)
- Anaphylaxis may occur but is rare 1
- Systemic iron toxicity with hepatocellular damage reported when doses exceed 300 mg maximum single dose 1
- Hypophosphatemia occurs in only 1% of iron sucrose patients (compared to 58% with ferric carboxymaltose) 1, 3
Critical Pitfalls to Avoid
- Never exceed 200 mg single dose to minimize dose-related anaphylactoid reactions 1, 3
- Do not administer during active infection, particularly bacteremia 3
- One pediatric case of systemic iron toxicity occurred with 16 mg/kg dose (approximately 900 mg for a 56 kg patient given as single dose) - this reinforces the 200 mg maximum single dose rule 1
- The only significant reaction in one pediatric series occurred when dose exceeded the recommended 300 mg maximum 1