Toxic iron (ferrous) overdose - paediatrics
Overview
Iron-containing supplements are a common source of accidental paediatric poisoning (frequent household source: prenatal/maternal vitamins). Acute iron ingestion can cause corrosive gastrointestinal injury, systemic toxicity (shock, metabolic acidosis), hepatocellular injury and late gastric outlet obstruction from scarring.
Management priorities in the emergency department are immediate resuscitation, early contact with specialist toxicology (NPIS/TOXBASE in the UK), targeted investigations (including appropriately timed serum iron) and consideration of directed decontamination and antidotal therapy (desferrioxamine) when indicated.
RCEM guidance and NPIS/TOXBASE should be consulted for agent‑specific recommendations (RCEM/NPIS; Resuscitation Council UK).
Pathophysiology (concise)
- Gastrointestinal mucosal corrosion from elemental iron causes early vomiting, abdominal pain and possible haematemesis.
- Absorbed free (non‑protein bound) iron catalyses free‑radical formation, impairs oxidative phosphorylation and causes mitochondrial dysfunction with cellular injury in vascular endothelium, myocardium and liver.
- Systemic effects produce vasodilatation, myocardial depression and lactic metabolic acidosis.
- Tablets can aggregate and remain in the stomach, causing focal mucosal necrosis and later stricture formation (gastric outlet obstruction).
Clinical course - classical phases
(Useful for assessment; not every patient follows these phases.)