IJzerintoxicatie: hoe zit dat eigenlijk? Intraveneuze en orale intoxicatie hetzelfde behandelen?

INTRODUCTION: Iron overdose can be fatal. After ingesting large amounts of iron tablets, the ensuing intoxication can be treated with chelation therapy (deferoxamine) according to guidelines. However, it is not known whether a patient should be treated after administering too much iron intravenously.

DESCRIPTION: A 79 year old female suffering from iron-deficiency anaemia erroneously received a double dose of ferric carboxymaltose (2x1000 mg Ferinject). 6.5 hours later her non-haemolytic serum iron level was 147 µmol/L (a serum level of > 90 µmol/L after iron tablet ingestion is considered to be a severe intoxication). In the absence of guidelines and despite lack of evidence, she was treated with 4500 mg of deferoxamine during 29 hours. 61.5 hours after treatment started, the serum iron level was 55 µmol/L. No acute complications were observed and there were no signs of long-term organ damage after two months follow-up.

DISCUSSION: The harmful effects of oral iron intoxication are believed to be the result of gastro-intestinal toxicity with ensuing inflammatory response and free radical formation facilitated by iron. Theoretically, only the latter process plays a role in intravenous iron intoxication. It is unknown what the consequences are of an untreated intravenous intoxication.

CONCLUSION: This case report suggests that deferoxamine can be used to eliminate iron and prevent end-organ damage after intravenous iron intoxication. It is our belief that treatment with deferoxamine should be considered in intravenous iron intoxication. However, it should be taken into account that available guidelines are based on oral iron intoxication and that clinical evidence is scarce.