Iron poisoning: What you need to know
The toxic effects of too much iron worsen over time and may result in death. Iron poisoning is always a medical emergency and is especially dangerous in children.
What is iron poisoning?
Too many iron supplements may cause iron poisoning.
Iron is essential in most biological systems in the body and is especially important for the bloodstream. Meats and some vegetables contain iron, and it is available in many over-the-counter and unregulated supplements.
Iron poisoning can be caused by:
- taking too many iron supplements
- a child taking an adult dose
- many blood transfusions
Excessive iron can remain in the stomach even after vomiting.
Too much iron can irritate the stomach and digestive tract, sometimes causing bleeding. Within hours of an acute overdose, the body's cells can be poisoned and their chemical reactions can be affected.
Within days, liver damage can occur. Weeks after recovery, scars from iron deposition can develop in the stomach, digestive tract, and liver as a result of the initial irritation.
There are several causes of iron poisoning, including overdose, iron overload, and genetic predisposition.
Acute iron toxicity is usually the result of an accidental overdose.
Most cases occur in children younger than 5 years old who accidentally eat iron supplements or adult multivitamins.
Iron overload is also known as chronic iron toxicity. Causes include:
- repeated blood transfusions to treat anemia
- excessive iron therapy, either intravenously for anemia, or with supplements
- liver diseases, such as chronic hepatitis C or alcoholism
Iron overload can occur naturally due to certain diseases. One example is hereditary hemochromatosis, which is a genetic condition that leads to abnormally increased absorption of iron in the body from food.
Symptoms and stages
Repeated blood transfusions may cause iron poisoning.
Iron poisoning usually causes symptoms within 6 hours of the overdose and can affect different parts of the body, including:
- airways and lungs
- stomach and intestines
- heart and blood
- nervous system
The symptoms of iron poisoning are typically divided into five stages:
Stage 1 (0-6 hours): Symptoms may include vomiting, vomiting blood, diarrhea, abdominal pain, irritability, and drowsiness. In serious cases, there may be rapid breathing, a rapid heart rate, coma, unconsciousness, seizures, and low blood pressure.
Stage 2 (6 to 48 hours): The symptoms and general condition of the affected person can appear to improve.
Stage 4 (2 to 5 days): Symptoms may include liver failure, bleeding, blood-clotting abnormalities, breathing problems, and even death. Decreased blood sugar can occur, along with confusion, lethargy, or coma.
Stage 5 (2 to 5 weeks): Stomach or intestines can become scarred. Scarring can cause abdominal blockages, cramps, pain, and vomiting. Cirrhosis can develop later.
To make a reliable diagnosis, a doctor will need to know about all supplements and medication being taken.
Early diagnosis and treatment are essential. Blood and urine tests, including tests to check iron levels, may not be reliable for diagnosis if they are not done promptly.
An iron poisoning diagnosis is usually based on the person's medical history, current symptoms, the presence of acid in their blood stream, and the amount of iron in their body.
During diagnosis, it is important that people tell their doctor about all current medications and supplements they are taking. Full disclosure is crucial because some supplements, such as vitamin C, can increase the absorption of iron in the body.
If the overdose is severe, the pills that are causing the iron poisoning can sometimes be seen on X-rays of the stomach or intestines.
The first stage of treatment for acute iron poisoning involves stabilizing the body, including any breathing or blood pressure problems.
Depending on the level of the poisoning, treatment may include cleansing therapies, such as whole bowel irrigation and chelation therapy. The idea behind these cleansing treatments is to get rid of the excess iron as quickly as possible and to reduce its toxic effects on the body.
Whole bowel irrigation
This procedure quickly flushes out the iron through the stomach and intestines. A person will either swallow a special solution or take it through a tube via the nose into the stomach. X-rays can detect and track iron tablets as they move through the system.
This therapy also gets rid of toxins in the body, ideally before they have time to do any lasting damage. A chemical solution is injected into the bloodstream and binds with excess toxic minerals, removing them from the body via the urine.
People with significant symptoms or high levels of iron in the blood may need hospitalization. Some people may require breathing support, or even heart monitoring.
Iron poisoning can result in serious, even life-threatening complications. Liver failure and heart failure are the main causes of death due to iron overdose.
If iron poisoning causes severe liver damage, it can lead to severe diabetes. Diabetes can result in abnormal body sugar levels, frequent urination, increased thirst and hunger, fatigue, blurry vision, numbness or tingling in the arms or legs and slow wound healing.
Heart failure can result in swelling of the legs, shortness of breath, trouble exercising, fatigue, fast or irregular heartbeat, and nausea.
In 1997, the U.S. Food and Drug Administration (FDA) introduced regulations on the labeling and packaging of vitamins and supplements that contain iron. These were designed to help prevent iron overdose, particularly in children.
Labels must specifically warn of the risk of acute iron poisoning in children under 6 years old.
Most products containing at least 30mg of iron per dose, such as iron pills for pregnant women, must be packaged individually in blister packs.
Unintentional iron poisoning can be prevented by closing containers properly and by storing them out of sight and reach of children.
Anybody planning to take any multivitamins or supplements that contain iron should consult a healthcare professional first. This is especially important if they intend to take more than one such supplement at the same time.
The outlook of iron poisoning varies depending on how much iron a person has consumed, whether they were taking any other drugs at the same time, and how long it took to start the treatment.
There is a good chance of recovery if treatment is started soon after the poisoning occurred.
If there is a delay in seeking treatment, severe liver damage can occur 2 to 5 days after the overdose. Delayed treatment also increases the risk of life-threatening complications.
An iron overdose can have very severe consequences in children, so caregivers should take extra precautions by keeping all medications out of sight and reach of children, even if the products have child-resistant packaging.