Acute iron poisoning

The continuous intravenous administration of deferoxamine is the preferred route and the recommended rate for infusion is 15 mg/kg per hour and should be reduced as soon as the situation permits, usually after 4 to 6 hours so that the total intravenous dose does not exceed a recommended 80 mg/kg in any 24 hour period.

The decision to discontinue Deferoxamine therapy must be a clinical decision; however, the following suggested criteria are believed to represent appropriate requirements for the cessation of Deferoxamine. Chelation therapy should be continued until all of the following criteria are satisfied:

• The patient must be free of signs and symptoms of systemic iron poisoning (e.g. no acidosis, no worsening hepatoxicity),
• Ideally, a corrected serum iron level should be normal or low (when iron level falls below 100 micro g/dL). Given that laboratories cannot measure serum iron concentrations accurately in the presence of Deferoxamine, it is acceptable to discontinue Deferoxamine when all other criteria are met if the measured serum iron concentration is not elevated.
• Repeat abdominal radiograph test should be obtained in patients who initially demonstrated multiple radio-opacities to ensure they have disappeared before Deferoxamine is discontinued because they serve as a marker for continued iron absorption,
• If the patient initially developed vin-rose coloured urine with Deferoxamine therapy, it seems reasonable that urine colour should return to normal before halting Deferoxamine (absence of vin-rose urine is not sufficient by itself to indicate discontinuation of Deferoxamine).

The effectiveness of treatment is dependent on an adequate urine output in order that the iron complex (ferrioxamine) is excreted from the body. Therefore if oliguria or anuria develop, peritoneal dialysis or haemodialysis may become necessary to remove ferrioxamine.

It should be noted that the serum iron level may rise sharply when the iron is released from the tissues.

1 g administered as a single intramuscular dose.

The decision to discontinue Deferoxamine therapy must be a clinical decision; however, the following suggested criteria are believed to represent appropriate requirements for the cessation of Deferoxamine. Chelation therapy should be continued until all of the following criteria are satisfied:

• The patient must be free of signs and symptoms of systemic iron poisoning (e.g. no acidosis, no worsening hepatoxicity),
• Ideally, a corrected serum iron level should be normal or low (when iron level falls below 100 micro g/dL). Given that laboratories cannot measure serum iron concentrations accurately in the presence of Deferoxamine, it is acceptable to discontinue Deferoxamine when all other criteria are met if the measured serum iron concentration is not elevated.
• Repeat abdominal radiograph test should be obtained in patients who initially demonstrated multiple radio-opacities to ensure they have disappeared before Deferoxamine is discontinued because they serve as a marker for continued iron absorption,
• If the patient initially developed vin-rose coloured urine with Deferoxamine therapy, it seems reasonable that urine colour should return to normal before halting Deferoxamine (absence of vin-rose urine is not sufficient by itself to indicate discontinuation of Deferoxamine).

The effectiveness of treatment is dependent on an adequate urine output in order that the iron complex (ferrioxamine) is excreted from the body. Therefore if oliguria or anuria develop, peritoneal dialysis or haemodialysis may become necessary to remove ferrioxamine.

It should be noted that the serum iron level may rise sharply when the iron is released from the tissues.

2 g administered as a single intramuscular dose.

The decision to discontinue Deferoxamine therapy must be a clinical decision; however, the following suggested criteria are believed to represent appropriate requirements for the cessation of Deferoxamine. Chelation therapy should be continued until all of the following criteria are satisfied:

• The patient must be free of signs and symptoms of systemic iron poisoning (e.g. no acidosis, no worsening hepatoxicity),
• Ideally, a corrected serum iron level should be normal or low (when iron level falls below 100 micro g/dL). Given that laboratories cannot measure serum iron concentrations accurately in the presence of Deferoxamine, it is acceptable to discontinue Deferoxamine when all other criteria are met if the measured serum iron concentration is not elevated.
• Repeat abdominal radiograph test should be obtained in patients who initially demonstrated multiple radio-opacities to ensure they have disappeared before Deferoxamine is discontinued because they serve as a marker for continued iron absorption,
• If the patient initially developed vin-rose coloured urine with Deferoxamine therapy, it seems reasonable that urine colour should return to normal before halting Deferoxamine (absence of vin-rose urine is not sufficient by itself to indicate discontinuation of Deferoxamine).

The effectiveness of treatment is dependent on an adequate urine output in order that the iron complex (ferrioxamine) is excreted from the body. Therefore if oliguria or anuria develop, peritoneal dialysis or haemodialysis may become necessary to remove ferrioxamine.

It should be noted that the serum iron level may rise sharply when the iron is released from the tissues.