Survival after a severe iron poisoning treated with intermittent infusions of deferoxamine

Karla Cheney, Carl Herbert Gumbiner, Blaine Benson, Milton Tenenbein

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Iron poisoning is the most common cause of overdose mortality in children under six years of age and there are no reports of survival with iron levels < 2687 μmol/L (< 15,000 μg/dL). A 22-month-old male was brought to the emergency department by his parents after ingesting an estimated 50 ferrous sulfate tablets (60 mg elemental iron/tablet) several hours earlier. Despite spontaneous emesis and gastric lavage his condition deteriorated and he was found to have a serum iron of 2992 μmol/L (16,706 μg/dL). During the first four days in the intensive care unit, he developed coma, metabolic acidosis, hypovolemic and cardiogenic shock, liver failure, coagulopathy and adult respiratory distress syndrome. He was treated with a unique deferoxamine dosage schedule (25 mg/kg/h for 12 h/d × 3 d), mechanical ventilation, Swan-Ganz catheter monitoring, dopamine/ nitroprusside therapy, blood product, bicarbonate, electrolyte and volume replacement. After a prolonged hospital course complicated primarily by gastric outlet obstruction he was dismissed on full oral feedings, gaining weight, and neurologically intact. Swan-Ganz catheter monitoring guided the management of this patient's shock, iron-induced cardiac failure, and deferoxamine mesylate induced adult respiratory distress syndrome. Further experience and research is required to determine the most appropriate deferoxamine mesylate dosing schedule and our experience expands the range for possible survival after massive iron overdose.

Original languageEnglish (US)
Pages (from-to)61-66
Number of pages6
JournalClinical Toxicology
Volume33
Issue number1
DOIs
StatePublished - Jan 1 1995

Fingerprint

Deferoxamine
ferrous sulfate
Poisoning
Iron
Survival
Adult Respiratory Distress Syndrome
Catheters
Tablets
Shock
Appointments and Schedules
Gastric Lavage
Gastric Outlet Obstruction
Child Mortality
Cardiogenic Shock
Liver Failure
Nitroprusside
Intensive care units
Bicarbonates
Coma
Acidosis

Keywords

  • ARDS
  • Cardiogenic shock
  • Deferoxamine
  • Iron poisoning

ASJC Scopus subject areas

  • Toxicology

Cite this

Survival after a severe iron poisoning treated with intermittent infusions of deferoxamine. / Cheney, Karla; Gumbiner, Carl Herbert; Benson, Blaine; Tenenbein, Milton.

In: Clinical Toxicology, Vol. 33, No. 1, 01.01.1995, p. 61-66.

Research output: Contribution to journalArticle

Cheney, Karla ; Gumbiner, Carl Herbert ; Benson, Blaine ; Tenenbein, Milton. / Survival after a severe iron poisoning treated with intermittent infusions of deferoxamine. In: Clinical Toxicology. 1995 ; Vol. 33, No. 1. pp. 61-66.
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