1.GI (Usually starts about 6 hours after ingestion; nausea and diarrhea; severe may be hemorrhagic)
2.Stable without symptoms (LATENT 6-12 hours)
3.Shock and acidosis (In severe cases can start as early as 6 hours; most patients who will die do so during this phase; AMS, heart/kidney failure)
4.Hepatotoxicity (LFTs and bilirubin may elevate with co-existent coagulopathy)
5.GI scarring (delayed; often weeks after the ingestions; may lead to significant pathology such as gastric outlet obstruction or intestinal obstruction)
Individuals demonstrate signs of GI toxicity after ingestion of more than 20 mg/kg.
Moderate toxicity occurs when ingestion of elemental iron exceeds 40 mg/kg.
Ingestions exceeding 60 mg/kg can cause severe toxicity and may be lethal.
A level at around 4 hours typically represents steady state. Levels earlier or later may misrepresent true levels. Hydration is a key initial therapy. Chelation is the standard of care. It is indicated for serum iron levels >350 mcg/dL with evidence of toxicity or >500 mcg/dL regardless of signs or symptoms.
NOTE: Activated charcoal does not significantly bind iron and whole bower irrigation is the standard decontamination method for iron overdose.