Suicidal iron overdose: A case report and review of literature

Abstract

Acute iron toxicity in adults is rare, usually occurring due to intentional ingestion in suicide attempts. Few cases of the clinical and autopsy findings in acute iron toxicity have previously been reported in the literature. Ingestion of large amounts of iron salts can lead to hemorrhagic shock, multi-system organ failure, coagulopathy, and death. We present the case of a 25-year-old man who reportedly ingested a large quantity of iron tablets along with ethanol in a suicide attempt and subsequently died approximately 65.5 h later. His clinical course and laboratory findings demonstrated hepatic and renal compromise with markedly elevated serum iron levels. At autopsy, iron encrustations were present over the gastric rugae. Superficial deposits of stainable iron were present overlying areas of mucosal necrosis with underlying submucosal fibrin thrombi. No significant stainable iron was present in the liver. Literature review revealed that the clinical course and laboratory testing of severe acute iron overdose is fairly non-specific. The length and type of treatment may alter the clinical course and laboratory results. Peak serum iron levels may be helpful in differentiating acute toxicity from chronic iron overload states. Gross findings of gastric iron encrustation are specific for acute ingestion when present.

Targeting ferroptosis protects against experimental (multi)organ dysfunction and death

“…We determined 300 mg/kg FeSO 4 to be the minimal dose needed to overrule the systemic buffer capacity and induce multiorgan injury (Supplementary Fig. 3a–d ), which is similar to what has been reported in human cases of iron intoxication 25 , 27 , 28 . A steady increase in iron was observed in several organs as a function of time, which was most prominent in the ileum, while plasma iron levels peaked shortly after injection and subsequently dropped (Fig.…”

Acute Iron Poisoning: A Case of Fulminant Hepatic Failure

“…6 The rescue treatment for acute liver failure is liver transplantation, but the outcomes are unpredictable in patients with iron overdose. 7 However, liver transplantation should be immediately considered in these cases. 4 Despite the high severity of the case, this patient's evolution was positive, with complete resolution after liver transplantation.…”

Liver Transplantation for Acute Hepatic Failure Following Intentional Iron Overdose

“…Iron chelating therapy with deferoxamine is the standard of care for patients with systemic toxicity. Liver transplantation as a lifesaving treatment for liver failure can be considered, but with few cases published, mostly in the pediatric age group and with variable outcomes [4,5].…”