In addition to GI decontamination, an iron level should be obtained 6 hours after ingestion. However, recent literature disputes the traditional maxim that a TIBC greater than the serum iron level is protective. However, the amount of magnesium needed is dependent on the serum iron level in each sample. There has not been a reliable method to add the required amount of magnesium for individual samples. Therefore, the inaccuracy of TIBC measurements in iron intoxication have eliminated this test as an indicator for chelation therapy.
Iron levels are useful for the indication of the severity of the ingestion.
In addition to binding free iron to enhance renal excretion, deferoxamine is thought to offer a protective effect from the intracellular toxicity of iron.10 This protective effect occurs by decreasing but not completely eliminating total free iron available to cellular binding sites. Further investigation is necessary before increased rates can be recommended. Depending on the initial severity of symptoms, deferoxamine therapy is stopped either immediately upon meeting these criteria or 24 hours later.10 Stage II, also known as the latent stage, occurs from 6 hours to 24 hours after ingestion. Due to the magnitude of circulatory collapse seen in patients with severe toxicity, it is imperative that aggressive fluid resuscitation be instituted immediately in addition to chelation therapy. Inotropes also may be required in addition to fluids.