Iron poisoning is an iron overload caused by a large excess of iron intake and usually refers to an acute overload rather than a gradual one. The terms has been primarily associated with young children who consumed large quantities of iron supplement pills, which resemble sweets and are widely used, including by pregnant women—see overnutrition (approximately 3 grams is lethal for a 2 year old[1]). Targeted packaging restrictions in the US for supplement containers with over 250 mg elemental iron have existed since 1978, and recommendations for unit packaging have reduced the several iron poisoning fatalities per year to almost nil since 1998.[2][3] No known cases of iron poisoning have been identified that are associated with iron mining.
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In nature, iron is usually found in its oxidized form, iron (III) oxide, which is insoluble. Ferrous iron is soluble and its toxicity varies, largely with the integrity of the gastrointestinal lining.
Iron supplements are typically used to treat anemia. Modalities include: diet, parasite control,[4] vitamin A, riboflavin (B2),[5] vitamin C (for absorption), folate, vitamin B12 and multivitamin-multimineral supplements,[6] with or without iron; potentially avoiding the use of iron only supplements.[7]
The amount of iron ingested may give a clue to potential toxicity. The therapeutic dose for iron deficiency anemia is 3–6 mg/kg/day. Toxic effects begin to occur at doses above 10–20 mg/kg of elemental iron. Ingestions of more than 50 mg/kg of elemental iron are associated with severe toxicity.[8]
The first indication of iron poisoning by ingestion is a pain in the stomach, as the stomach lining becomes ulcerated. This is accompanied by nausea and vomiting. The pain then abates for 24 hours as the iron passes deeper into the body and damages internal organs, particularly the brain and the liver, and metabolic acidosis develops. The body goes into shock and death from liver failure.
If intake of iron is during a prolonged period of time, symptoms are likely similar to other causes of iron overload.
Later stage treatment consists of cleaning the iron from the blood, using a chelating agent such as deferoxamine. If this fails then dialysis is the next step.
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