Abstract
Background
Management of oral iron overdoses is well-established, but there is limited literature
regarding intravenous iron sucrose overdoses. Indications for administering deferoxamine
after oral iron overdoses include clinical signs and symptoms of toxicity, along with
a serum iron concentration ≥ 500 μg/dL. Reported signs and symptoms of iron sucrose
overdose do not appear to correlate with those of oral iron overdoses.
Case Report
We present a case of intravenous iron sucrose overdose in a clinically well-appearing
patient with a presenting serum iron concentration that was several times higher than
the usual threshold concentration for initiating deferoxamine treatment. A 21-year-old
woman presented to the emergency department after an accidental intravenous iron sucrose
overdose. The patient received a home infusion of 1000 mg iron sucrose, which was
five times the prescribed dose. Her presenting serum iron concentration was 1799 μg/dL,
with bicarbonate and anion gap both within normal limits and an unremarkable physical
examination. Because she did not have evidence of severe iron toxicity, she was treated
supportively and deferoxamine was not administered. Her serum iron concentration decreased
below the toxic range over the next 14 h, and she was discharged home the next day.
Why Should an Emergency Physician Be Aware of This?
This patient was managed successfully with expectant care alone, suggesting that iron
sucrose overdose has much lower toxicity than oral iron salt overdose. This discrepancy
between measured iron concentrations and clinical presentation may be explained by
the elimination kinetics of iron sucrose having separate redistribution and elimination
phases.
Keywords
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References
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- Deferoxamine.in: Brent J Burkhart K Dargan P Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient. Springer International Publishing, 2017: 2771-2777
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Article info
Publication history
Published online: September 09, 2022
Accepted:
September 4,
2022
Received in revised form:
July 17,
2022
Received:
March 25,
2022
Identification
Copyright
Published by Elsevier Inc.
