Iron Toxicity

What is Iron Toxicity

Iron is a mineral required by the body for optimal functioning. Supplements that contain iron are widely available to help individuals who are suffering from a deficiency. If the amount of iron in the system exceeds the therapeutic level, it will lead to symptoms and other adverse effects ^{[1, 2]}.

What is Iron?

Iron is required by the body in producing blood cells that is responsible in the distribution of oxygen in the body. This mineral is also an important component of several enzymes and neurotransmitters in the body.

If the amount of iron is low, the patient may suffer from conditions such as anemia or low red blood cell count. Those who have iron deficiency are either advised to eat food rich in iron such as lean beef, chicken, seafood and green leafy vegetables or take an over-the-counter iron supplement. Side effects that are associated with the intake of iron supplements are stomach pain, vomiting, nausea and the presence of green or dark stools ^{[1, 2, 3, 4]}.

How much is Iron Toxicity?

The normal level of iron in the body is 55-160µg/dL in men and 40-155µg/dL. Individuals whose iron levels are below these levels may be advised to take 3-6mg/kg/day of elemental iron. If an individual takes in about 10-20mg/kg of elemental iron, initial signs of iron toxicity may manifest.

Symptoms of a severe iron toxicity will present itself if more than 60mg/kg of elemental iron has been taken. Iron supplement in the form of ferrous sulfate contains 20% elemental iron, ferrous gluconate has 12% elemental iron while a ferrous fumarate preparation has the highest elemental iron content at 33% ^{[1, 2, 3, 4, 5]}.

What are Iron Toxicity symptoms?

There are 5 known stages of iron toxicity and they occur related to the time of ingestion. The 1^st stage of the toxicity will occur 6 hours after taking the drug. The person will present with vomiting, explosive diarrhea, pain in the abdomen, irritability or they may even be lethargic.

If the amount of iron taken is more than 60mg/kg, there will be increased heart rate, increased respiration, low blood pressure and they may fall into a coma. This will be followed by a period of latency in which the patient may seem to improve after 24 hours.

If the patient still does not receive medical attention after 48 hours, symptoms like seizures, shock, fever and problems with coagulation. This will lead to failure of the liver, jaundice and hypoglycemia. After about 2-5 weeks, a gastric outlet or duodenal obstruction may occur as a consequence of scarring in the stomach or intestines ^{[1, 2, 3, 4, 5]}.

What is Iron Toxicity Treatment?

When a patient who is experiencing iron overdose is brought to the hospital, the priority is to maintain a venous access. Most of these patients are suffering from hypovolemia and they should be given boluses of isotonic crystalloids in order to maintain their hemodynamic instability.

Those who are in shock may also be provided with oxygen support. Ipecac is a medication use to induce vomiting in patients. This drug is recommended to be given 60 minutes after the ingestion had occurred. Although this drug if effective in reducing the amount of iron ingested, it is not used regularly because it may hide the vomiting caused by the overdose.

A gastric lavage may also be performed to reduce the amount of iron in the stomach. Deferoxamine is an antidote for severe levels of iron toxicity because it chelates the free serum iron. It is given to patients until hypotension occurs in the patient. The prognosis is good if the symptoms are managed within 48 hours after excessive amount of iron is take. Irreversible liver damage may occur if the condition has not been managed after 2-5 days ^{[1, 2, 3, 4, 5]}.

How to prevent Iron Toxicity?

Although iron supplements may be procured even without a prescription, a physician should be advised before taking this medication. Accidental ingestion is very rampant especially in children because of the candy-like appearance of these supplements. Iron supplement bottles should be kept in a place out of children’s reach in order to prevent this from happening ^{[1, 2, 3, 4, 5]}.

References

1. Spanierman, C. S. (2015, December 4). Iron Toxicity. Retrieved from Medscape: http://emedicine.medscape.com/article/815213-overview
2. University of California San Francisco. (2016). Hemoglobin and Functions of Iron. Retrieved from University of California San Francisco: https://www.ucsfhealth.org/education/hemoglobin_and_functions_of_iron/
3. Drugs.com. (2016, October 1). Iron. Retrieved from Drugs.com: https://www.drugs.com/cdi/iron.html
4. Heller, J. L. (2015, October 13). Iron overdose. Retrieved from Medline Plus: https://medlineplus.gov/ency/article/002659.htm
5. O’Malley, G., & O’Malley, R. (2016). Iron Poisoning. Retrieved from Merck Manual Professional Version: http://www.merckmanuals.com/professional/injuries-poisoning/poisoning/iron-poisoning

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