Acute Iron Poisoning - Causes, Symptoms, Diagnosis, and Treatment

What Is Acute Iron Poisoning?

Acute iron poisoning is when a child or person ingests excess iron supplements, mostly vitamins, which cause toxicity or poisoning in the body.

What Are the Causes of Iron Poisoning in the Body?

Iron poisoning can be caused due to multiple reasons, such as:

• First, it can occur due to accidental ingestion of iron, causing an overdose.

• Iron toxicity can occur in young children (above five years) by accidentally ingesting iron or other adult multivitamin supplements.

• Third, chronic iron toxicity can occur due to multiple blood transfusions to treat anemia.

• Excessive alcohol intake or Hepatitis C causing liver diseases can cause iron toxicity in the body.

• Fourth, Intravenous Iron therapy to treat anemia can cause toxicity.

• Finally, an abnormal increase in iron can be naturally caused by genetic reasons (Hemochromatosis).

What Are the Signs and Symptoms of Acute Iron Poisoning?

Iron poisoning can occur within a few hours of iron ingestion and can irritate the stomach, intestinal lining, and other organs, producing symptoms such as:

• Abdominal pain.

• Dehydration.

• Diarrhea.

• Severe vomiting with blood.

• Bluish or grayish skin discoloration.

• Jaundice.

• Headache.

• Dizziness.

• Fever.

• Seizures.

• Shortening of breath.

• Fluid-filled lungs.

What Are the Stages of Iron Toxicity in the Body?

Progression of iron toxicity at various stages occurs rapidly, and every person responds differently and may or may not pass through every stage:

• Stage one lasts approximately 0.5 to 6 hours and causes only gastrointestinal symptoms like vomiting, diarrhea, or abdominal pain.

• Stage two occurs between 6 to 24 hours, and gastric symptoms usually resolve in this phase, but iron toxicity is still present in the body.

• Stage three starts from 6 to 72 hours, causing metabolic acidosis, shock, and recurrences of gastrointestinal symptoms. Renal failure, hepatic dysfunction, and iron-induced coagulopathy also occur in this phase.

• Stage four starts between two to five days, leading to advancement in hepatic failure and an increase in aminotransferase levels.

• The fifth and last stage starts from two to eight weeks, showing results of healing gastrointestinal mucosa and obstruction caused by poisoning.

What Are the Complications and Risks Associated With Acute Iron Poisoning?

If iron poisoning is not treated, liver failure can develop within a few days. During this time, bleeding or blood clotting issues may also arise. Without effective treatment, iron poisoning can lead to scarring of the stomach and intestines, causing significant digestive problems. Additionally, permanent scarring of the liver, known as cirrhosis, can occur. The most common causes of death from iron poisoning are liver failure and circulatory shock.

Why Is Iron Overdose Dangerous for the Human Body?

Iron overdose is dangerous because it can affect the body in many ways, apart from causing toxicity or poisoning.

This includes:

• Arrhythmia.

• Enlarged liver.

• Liver diseases.

• Heart failure.

• Liver cancer.

• Liver cirrhosis.

• Erectile dysfunction (in men).

• Early Menopause (in women).

• Arthritis.

• Diabetes.

How Can We Diagnose Iron Poisoning in the Body?

• Blood and urine tests to check iron levels in the body.

• Diagnosis is mainly based on signs and symptoms of iron poisoning, a person's medical history, and iron toxicity levels in the body.

• The consultant must share complete information about the present medical conditions and if one is taking any supplements.

• Pills causing excessive toxicity can be seen in the stomach and intestines through X-rays.

How To Treat Acute Iron Poisoning?

• Bowel irrigation or stomach cleaning with a nasogastric tube carrying polyethylene glycol solution can help remove iron toxicity from the body. In addition, the movement of the solution can be tracked inside the body with X-rays.

• In some cases, chelating therapy is needed to remove toxicants through urine. The person is given an IV or intravenous shot of Deferoxamine mesylate that binds with the iron content in the blood and gets excreted through urine. However, children are usually given only 24 hours of chelating therapy. Deferoxamine mesylate can produce side effects like low blood pressure and urine color change. Therefore, toxicologists must be consulted urgently.

• Pumping the stomach or orogastric lavage can help remove iron intoxication if done during the initial hours of iron ingestion.

• Fresh frozen plasma and vitamin K therapy can be given to treat coagulopathy.

• Activated charcoal treatments are not effective in case of iron poisoning, hence should be avoided.

What Is the Outlook for Iron Poisoning?

Full recovery is likely for children or adults who show no symptoms for at least six hours after swallowing pills. Those who exhibit symptoms may become ill and require more intensive treatment. Iron poisoning can progress through several stages. A late stage, known as the hepatic stage, develops two to five days after ingestion and may involve elevated liver enzymes, potentially leading to liver failure. Another late stage involves gastrointestinal scarring, which can occur four to six weeks after ingestion. This final stage may present with early satiety (feeling full after eating) or nausea due to GI scarring and obstruction.

What Is Hemochromatosis (Iron Overload)?

Hemochromatosis, or iron overload, occurs when our body stores excess iron and causes damage to the liver, pancreas, and heart. This condition is usually of genetic origin, known as hereditary or primary hemochromatosis. However, in some cases, it can be secondary also due to any medical conditions or results of medical treatments. These include:

• Kidney dialysis for a prolonged period.

• Blood transfusion.

• Anemia.

• Iron injections or pills.

• Liver or fatty liver disease.

Symptoms:

Joint pain, stomach pain, fatigue, general weakness, weight loss.

Diagnosis:

• Genetic Testing- It helps to check the inherited congenital form of hemochromatosis.

• Liver Biopsy- Liver tissues are removed with the help of a thin needle to study under the microscope.

• MRI (Magnetic Resonance Imaging)- It helps check vital organs.

Treatment:

• Iron Chelation Therapy - This therapy removes excess iron from the body by ingesting it through the mouth or injecting it into the bloodstream by a professional.

• Therapeutic Phlebotomy - In this technique, a tube and needle are used to remove blood from the body and the iron content to check for iron levels repeatedly through blood tests. This procedure is repeated frequently.

• Changed Diet Plan - It is advised to restrict yourself from taking iron supplements and vitamin C. Alcohol consumption is also prohibited as it can damage liver functioning.

Conclusion

Iron supplements can be easily purchased from over-the-counter stores. Accidental ingestion by children or intentional overdose of iron supplements can cause toxicity in the body. Children ingesting adult dose preparations or multivitamins can lead to severe and life-threatening poisoning. Various other medical conditions can cause iron toxicity, but precautions must be taken at home to prevent any accidental situations. Reach out to the nearest medical care center for help in case of an emergency.