National Poisons Information Service

A service commissioned by Public Health England

 

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Members of the public

seeking specific

information on poisons

should contact:

 

In England and Wales:

NHS 111 - dial 111

 

In Scotland:

NHS 24 - dial 111

 

In N Ireland:

Contact your local GP or

pharmacist during

normal hours; click here

(www.gpoutofhours

.hscni.net/) for GP

services Out-of-Hours.

 

In Republic of Ireland:

01 809 2166

 

Healthcare

professionals seeking

poisons information

should consult:

www.toxbase.org

Iron poisoning

Iron poisoning is potentially serious but there are limited data available on the most appropriate dose and duration of treatment with the antidote desferrioxamine (DFO). To address this, the NPIS set up a prospective study in 2014 collecting data on iron poisoning cases presenting to hospital. For an initial period (1 February 2014 - 17 January 2016), inclusion criteria included ingestion of a potentially toxic dose of iron (≥20 mg/kg), presence of symptoms, raised serum iron concentration (greater than or ≥55 micromoles/L), or treatment with DFO. Inclusion criteria were adjusted for the period 18 January 2016 to 17 January 2017; during this period only patients receiving DFO were followed up actively.


Over the study period (18 January 2016 - 17 January 2017), the NPIS received 694 calls relating to iron exposures, the majority from hospitals (54.9%). Following exclusions (skin/eye contact; exposure to rust, fertiliser, moss killer, weed killer or slug bait) 310 individual patient enquiries from hospitals were analysed. Monthly call numbers remained consistent with the previous study period (1 February 2014 - 17 January 2016). There were 95 patients aged 15 or younger and 36 patients under five years of age.

 

At the time of the enquiry, most patients were asymptomatic (47%) or had minor features (43%), with moderate (7.4%) or severe (1.9%) features less common. Severity was not known for 0.6% of cases.


The maximum poisoning severity score (PSS, see Section 2) for each patient was recorded as follows: asymptomatic 32.9%; minor features 53.5%; moderate features 10.6% and severe features 1.6%. The maximum PSS was not known in 1.3% of cases. At follow up, no deaths were recorded (in contrast to the previous period: 1 February 2014 - 17 January 2016) where four deaths were recorded; however, on review none of these were considered likely to be caused by the iron content of the overdose; three were mixed overdoses which included cardiovascular agents in unknown amounts, and the fourth was an elderly patient with pre-existing chronic heart failure.

 

Twenty patients received DFO following iron overdose (6.4% of all cases). In ten of these cases (50%), iron was ingested alone; three were asymptomatic, six had minor features and one moderate features at the time of presentation. The total dose/kg of DFO administered was known for six (30.0%) of these patients (53 mg/kg; 57 mg/kg; 73 mg/kg; 79 mg/kg; 80 mg/kg and 80 mg/kg; IQR 18.75 mg/kg). Two patients were known to have received doses of 4 g and 6 g, however, as a body weight was not recorded it was not possible to determine dose/kg. In the remaining twelve patients the total dose of DFO administered could not be determined on follow up.

 

Enquiries about iron poisoning are an important part of the NPIS’s workload but few cases are severe and relatively few patients in the study period were treated with the antidote DFO (compared for example with the 40% to 50% of paracetamol poisoned patients who receive the antidote acetylcysteine) Through a detailed analysis of this data, we hope to further clarification and education about the appropriate investigation and management of patients with iron poisoning.


Information from the NPIS Annual Report 2016/17.

 

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