Fatal overdose of iron tablets in adults

Abstract

Acute iron toxicity is usually seen in children with accidental ingestion of iron-containing syrups. However, the literature on acute iron toxicity with suicidal intent in adults is scant. We report, the first instance of two adults with fatal ingestion of a single drug overdose with iron tablets from India. Two young adults developed severe gastro-intestinal bleeding and fulminant hepatic failure 48 h after deliberate consumption of large doses of iron tablets. Serum iron levels measured 36 h after ingestion were normal presumably due to the redistribution of iron to the intracellular compartment. Despite aggressive supportive management in medical intensive care unit of a tertiary care hospital, the patients succumbed to the toxic doses of iron.

Fatal iron toxicity in adults

“…1,2,7 Desferrioxamine is the only approved iron chelator available and administered as a continuous intravenous infusion at 15 mg/kg/hr.2,7Administration of desferrioxamine after acute intoxication may color the urine a pinkish red, a phenomenon termed "vinrose urine". 3 Disappearance of the 'vin rose' discoloration has often been taken as an endpoint to iron chelation. N-acetyl cysteine is used when hepatotoxicity is evident in pure ferrous sulphate overdose.…”

“…Iron poisoning is most commonly seen in children but rarely in adults. 2,3 Among adults, it has been described as accidental overdoses (mainly in pregnancy) and as suicidal attempts. 4 Clinical outcome is variable and depends on the quantity of iron ingested, other drugs ingested and the time to receive treatment.…”

“…4 Clinical outcome is variable and depends on the quantity of iron ingested, other drugs ingested and the time to receive treatment. 3 We report two cases: The first, of an 18-year-old girl who, despite our best efforts, died from intra-cranial hemorrhage 1 week following the ingestion of iron tablets and the second, the case of a 33 year old who recovered after receiving timely intervention following early presentation. The authors would like to draw attention to the diverse presentation of iron toxicity in patients and to stress on the fact that early intervention is an important prognostic factor.…”

Fatal iron toxicity in an adult: Clinical profile and review

“…Iron is the most abundant trace element in the body and is essential in most biological systems. [1] Iron is an intracellular poison, and it exerts its toxic effect on mitochondria by shunting electrons away from the electron transport chain, uncoupling the oxidative phosphorylation, thus leading to anaerobic metabolism. [2] Iron poisoning in an adult is uncommon.…”

“…[2] Iron poisoning in an adult is uncommon. Most of the cases of iron poisoning reported in literature are of pediatric age group,[234] while only four cases[156] were of older age group.…”