Patient handout

Iron overdose

PRODUCTION

1. Your condition

This handout is for iron overdose. Your care team identified this based on: reported ingestion of iron / ferrous salt / prenatal-multivitamin.

Other reasons your team may use this plan: child found with open prenatal/adult ferrous bottle (classic lethal scenario); elevated serum iron level (4–6 h post-ingestion peak); radio-opaque tablets / pill mass on abdominal radiograph.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
isotonic_crystalloid_resuscitation	20 mL/kg boluses (peds) / 1–2 L (adult), titrate to perfusion	IV	repeat to endpoint	AACT/EAPCCT — iron causes hypovolemic + distributive + cardiogenic shock; aggressive volume is the resuscitative cornerstone
sodium_bicarbonate	1–2 mEq/kg IV bolus then infusion titrated to pH	IV	titrated	Correct severe anion-gap lactic acidosis driving cellular toxicity (adjunct to perfusion restoration, not a substitute)
fresh_frozen_plasma_vitamin_k	FFP 10–15 mL/kg ± vitamin K 5–10 mg	IV	guided by INR / bleeding	Iron-induced coagulopathy (early direct effect + later hepatic synthetic failure) — correct for active bleeding/procedure

Plan: Iron poisoning — staged management (resuscitate → decontaminate → chelate → support → late strictures)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Hypotension / distributive-hypovolemic-cardiogenic shock OR severe anion-gap metabolic acidosis (stage 3) — AACT/EAPCCT(life-threatening)
Serum iron >1000 µg/dL (severe) OR >500 µg/dL with clinical symptoms — AACT/EAPCCT(life-threatening)
Significant clinical toxicity (persistent vomiting/hematemesis, AMS, acidosis) regardless of serum iron level — AACT/EAPCCT
Rising transaminases / INR / hypoglycemia / encephalopathy 12–96 h post-ingestion — centrilobular necrosis (second leading cause of death) — critical-care tox review 2024-2025(life-threatening)
Large radio-opaque tablet burden / pill mass on abdominal radiograph or massive elemental ingestion (>60 mg/kg) — Manoguerra/AAPCC triage guideline
Altered mental status / coma OR coagulopathy with active bleeding — AACT/EAPCCT(life-threatening)

5. Follow-up

Late (2–8 wk) gastric-outlet/bowel-obstruction surveillance for strictures/scarring; GI follow-up; psychiatry safety plan if intentional; poison-prevention education + child-protection if pediatric

6. Sources

Guideline: AACT/EAPCCT position statements (whole-bowel irrigation; single-dose activated charcoal) + 2024-2025 critical-care toxicology reviews + Manoguerra/AAPCC iron ingestion out-of-hospital triage guideline