Iron poisoning is a leading cause of poisoning deaths in children. Symptoms begin with acute gastroenteritis, followed by a quiescent period, then shock and liver failure. Diagnosis is by measuring serum iron, detecting radiopaque iron tablets in the gastrointestinal tract, or detecting unexplained metabolic acidosis in patients with other findings suggesting iron poisoning. Treatment of a substantial ingestion is usually whole-bowel irrigation and chelation therapy with IV deferoxamine .
(See also General Principles of Poisoning.)
Many commonly used over-the-counter (OTC) preparations contain iron. Of the many iron compounds used in OTC and prescription preparations, the most common are
Ferrous sulfate (20% elemental iron)
Ferrous gluconate (12% elemental iron)
Ferrous fumarate (33% elemental iron)
To children, iron tablets may look like candy. Prenatal multivitamins are the source of iron in most lethal ingestions among children. Children’s chewable multivitamins with iron usually have such small amounts that toxicity rarely occurs.