Iron poisoning

D ron poisoning has always been of particular interest to pediatricians: children are frequently exposed to iron-containing products, and they experience the worst toxicity. The first well-described cases of iron poisoning were published in the 1940s and 1950s, the classic animal experiments were performed in the 1950s and 1960s, and the use of the chelator deferoxamine as an antidote for iron poisoning was introduced in the 1960s. Most of what we know about the clinical presentation, the pathology, and the pathophysiology of iron poisoning comes from this early work although research continues. What has changed most over the past 50 years is the approach to management. As with many types of poisoning, there is now an emphasis on excellent supportive care with an individualized approach to gastrointestinal decontamination and a selective use of antidotes. With this strategy, the deaths related to iron poisoning have been reduced to only a small number each year. This article reviews the epidemiologic, clinical, animal, and laboratory science related to iron poisoning and its management and focuses on several areas of controversy.