Liverpool Hospital Emergency Department

Indications for use – Iron toxicity 

  • Severe systemic toxicity – Metabolic acidosis, shock, GI bleeding, coma
  • Peak serum iron >90micromol/L (>5mg/L) at 4-6hr
  • Convincing ingestion >60mg/kg with symptoms and evidence on XR if tablet  formulation 

Formulation 500mg vial: 

  • Reconstitute the 500 mg powder with 5 mls sterile water for injection and dilute to  100 mls with 5% glucose or 0.9% normal saline 

Dosage and Administration 

  • Discuss with Toxicologist
  • 15mg/kg/hr IV Infusion to maximum 90mg/kg/24hrs
  • Rate increased to maximum 35mg/kg/hr if required (persistent instability)
  • Dosage same for Adults, Children and in Pregnancy. 
  • Severe renal impairment -> 50% dose reduction
  • Do not use beyond 24hours unless toxicology guided
  • Cardiac monitoring mandatory 

Treatment aim = Iron Level <60mmol/L + improving metabolic status

Consultation with toxicologist prior to cessation 

Adverse Effects 

  • Hypotension/flushing/urticaria (Histamine release)
  • Orange-Red urine (chelated Iron)
  • ARDS/Respiratory toxicity if prolonged use >24hrs
  • toxic retinopathy
  • Yersinia sepsis (the ferrioxamine complex is a siderophore that promotes growth) 

Pit Falls 

DO NOT BE FOOLED BY +6-24hr Asymptomatic window 

  • Multifactorial shock – Adequate fluid +/- blood products in GI Bleeding
  • Consider whole bowel irrigation in significant ingestions
  • Consider Endoscopy for tablet removal ?Laparotomy for pharmacobezoar removal
  • Infusion related hypotension -> IV Fluids usually corrects
  • Consider NAI in children
  • Mental health schedule in adults