Is an iron preparation containing 220 mg elemental iron per 5 mL safe for a 13‑year‑old adolescent with a hemoglobin of 10.3 g/dL?

Safety of 220 mg/5 mL Iron Preparation in a 13-Year-Old with Hemoglobin 10.3 g/dL

No, a preparation containing 220 mg elemental iron per 5 mL is NOT safe for a 13-year-old child—this represents a massive overdose that could cause severe toxicity or death.

Critical Dosing Error

The formulation you describe appears to be incorrectly stated or represents a dangerous concentration:

• Standard therapeutic dosing for adolescents with iron deficiency anemia is 3 mg/kg/day of elemental iron 1
• For a typical 13-year-old weighing approximately 40-50 kg, the appropriate daily dose would be 120-150 mg elemental iron total per day 1
• A single 5 mL dose of "220 mg/5 mL" would deliver 220 mg—exceeding the entire daily requirement in one dose 1

Toxicity Threshold

Acute iron ingestion of ≥40 mg/kg elemental iron requires immediate referral to an emergency facility 2:

• For a 40 kg adolescent, this threshold is 1,600 mg
• For a 50 kg adolescent, this threshold is 2,000 mg
• While a single 5 mL dose (220 mg) would not reach acute toxicity thresholds, repeated dosing at this concentration would rapidly approach dangerous levels 2

Correct Formulations for Adolescents

Standard iron preparations contain far less elemental iron per dose 3, 4:

• Ferrous fumarate liquid: 45 mg elemental iron per 5 mL 3, 4
• Sodium feredate liquid: 27.5 mg elemental iron per 5 mL 3
• Ferrous sulfate tablets: 65 mg elemental iron per 200 mg tablet 3

Recommended Approach for This Patient

For a 13-year-old with hemoglobin 10.3 g/dL (mild anemia):

• Prescribe a standard oral iron preparation such as ferrous sulfate 200 mg tablets (65 mg elemental iron) once daily, or ferrous fumarate liquid 45 mg/5 mL 3, 1
• Administer between meals (at least 2 hours before or 1 hour after food) to maximize absorption 1, 4
• Recheck hemoglobin after 4 weeks—expect an increase of ≥1 g/dL if iron deficiency is the cause 1
• Continue treatment for 2-3 months total to replenish iron stores after hemoglobin normalizes 1

Common Pitfalls

• Do not use modified-release preparations—they are less suitable for prescribing due to unpredictable absorption 3
• Verify the actual elemental iron content of any liquid preparation before dispensing—pharmaceutical errors in compounding or labeling can be fatal 2
• Counsel on gastrointestinal side effects (nausea, constipation, dark stools) which are common but should not prompt discontinuation unless severe 1, 4