context: Iron poisoning occurs when a person, usually a child, swallows a large number of iron-containing pills, most often vitamins. Acute iron poisoning mainly involves children under age 6 who swallow pediatric or adult vitamins containing iron. These children may not be able or willing to tell you what and how much they swallowed. Iron salt is available in multiple preparations. For instance, ferrous sulfate is available as drops, syrup, elixir, capsules, and tablets. Iron preparations are widely used and are available without a prescription and may be housed in bottles with or without child resistant closures. The amount of iron that will cause poisoning depends upon the size of the child. An 8-year-old may show no symptoms from an amount that would cause serious symptoms in a 3-year-old. Symptoms appear at doses greater than 20 mg/kg (based on the body weight of the child). Iron is available in different oral forms. A child may show no symptoms after eating a number of pills that might have looked like candy. The only evidence may be an opened vitamin bottle. If you know, or even suspect, that a child has eaten tablets, you should consult a hospital's emergency department or a poison control center regarding a possible iron poisoning. Iron pills can look like candy to children. Intentional overdose can occur among adults, but is rare. Symptoms of iron poisoning usually become evident within 6 hours after an excessive amount of iron is swallowed. Iron corrodes your intestinal lining and is a direct irritant to the stomach. People with iron poisoning can have the following symptoms: Severe vomiting Diarrhea Abdominal pain Dehydration and lethargy if not treated adequately In a child, bloody vomit or stool Often, after supportive care, the gastrointestinal symptoms appear to improve within 6 to 24 hours after their onset. If profound poisoning is inadequately treated, shock and death can occur. 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 20 mg/kg of elemental iron. Ingestions of more than 60 mg/kg of elemental iron are associated with severe toxicity. Call your doctor, local poison control center, or go directly to the closest hospital's emergency department if you suspect your child has swallowed iron-containing vitamins, even if your child shows no symptoms. Bring the container with you. If you find your child among iron pills or pill containers, or your child tells you he or she swallowed pills, take the child to a hospital's emergency department. If you can, tell the doctor the type of iron supplement and the number of tablets your child swallowed. The diagnosis of iron poisoning is usually made by observing your child. A normal physical exam and no symptoms for 6 hours tells the doctor that the child has experienced either little poisoning or did not eat any iron-containing substances. The doctor may draw blood from your child to determine these levels: Iron Blood cell count Blood Chemistry The doctor may also ask for an X-ray of your child's abdomen to confirm whether there are iron pills in the gastrointestinal tract, although sometimes the pills can be there and not seen. Laboratory and imaging tests are not usually sensitive enough to detect poisoning. Some tests are also too slow to affect the diagnosis and management of iron poisoning. If your child is diagnosed with iron poisoning, the doctor will first make sure your child is breathing normally. Then your child will likely have his or her bowel cleaned by drinking a special liquid. Severe poisonings will require IV (intravenous) chelation therapy. The patient receives a series of IVs containing deferoxamine mesylate ( Desferal), a chemical that binds to iron in the blood and is then excreted in urine. Deferoxamine can be administered by IV or shot, but the IV route is preferred for easier dose adjustment. A change in urine color to a red-orange and low blood pressure are common side effects with deferoxamine treatment. Usually children require no more than 24 hours of therapy. Orogastric lavage, or pumping of the stomach, may be considered. But generally, it is only helpful if performed within 1 hour of swallowing the pills. Insertion of the tube can cause complications, and many pills may not fit through the ports of a lavage tube if they are not disintegrated. If the doctor suspects your child has also swallowed other medications, he or she may give your child activated charcoal to drink. Activated charcoal does not bind to iron, but it may be useful in absorbing other medications. If you suspect your child has accidentally swallowed iron tablets, call your doctor or poison control center immediately. You can contact the American Association of Poison Control Centers 24 hours a day, seven days a week at 1-800-222-1222. Do not attempt to induce vomiting, either manually or with syrup of ipecac. This will make it more difficult to assess whether your child is truly iron toxic. Bring the medicine containers along with you to the hospital. Keep medications where children cannot get to them. Childproof caps are not a guarantee that children are safe. Educate your children that unknown pills are not candy and can be harmful. Full recovery is likely for children (or adults) who show no symptoms for at least 6 hours after swallowing pills. Those with symptoms may be ill and require more aggressive treatment. Iron poisoning can progress through several stages. A late, or hepatic stage, develops 2-5 days after ingestion. The person may have elevated liver enzymes, possibly resulting in liver failure. Another late stage involves gastrointestinal scarring. Some 4-6 weeks after ingestion, the final stage manifests with early satiety (fullness after eating) or nausea from GI scarring and obstruction. iron poisoning, poisoning, vitamin poisoning, iron-containing pills, vitamins with iron, poison proofing