In these patients, evaluation of airway, breathing, and circulation is of primary importance. Intravenous access should be obtained for maintenance fluid requirements along with isotonic fluid resuscitation needed to keep up with ongoing losses and hypotension. Pressors may be required because of myocardial injury or ferritin induced vasodilatation. If indicated, decontamination in the emergency department should include gastric lavage with normal saline. Ipecac only delays lavage and may cause persistent vomiting.
Charcoal is ineffective.
Other lavage solutions, such as sodium bicarbonate or phosphate, theoretically diminish iron absorption by making iron insoluble. Impractically large volumes must be used to achieve this effect, however, and these solutions furthermore lend themselves to electrolyte imbalances. Lavage with deferoxamine is contraindicated, since, when complexed with iron to form ferrioxamine, absorption of iron may actually increase. After lavage, patients with positive initial radiographs should have repeat films. If vomiting of the solution occurs, slow the administration rate and titrate up to achieve the maximal tolerated rate.