Chronological Changes in Urine Color and Serum Iron Levels After Deferoxamine Administration in Acute Iron Poisoning

Acute iron poisoning is rare but potentially fatal. Deferoxamine (DFO) is the standard chelating agent and the appearance of "vin-rose urine" has traditionally been considered a marker of effective chelation; however, its relationship with serum iron concentration over time remains unclear. A 17-year-old female patient presented with abdominal pain and acute liver dysfunction 43 h after intentional ingestion of sodium ferrous citrate (approximately 40 mg/kg of elemental iron). Continuous intravenous DFO was administered at a dose of 100 mg/kg for approximately 6 h. The urine color changed to vin-rose within 1 h and normalized 12 h after DFO initiation. Despite the normalization of urine color, abdominal pain persisted. Serial laboratory analyses showed that serum iron levels transiently decreased, but then increased repeatedly, even after the normalization of urine color. This case provides chronological documentation of urine color changes alongside serial measurements of serum iron and ferritin, illustrating that the normalization of urine color does not necessarily indicate the normalization of serum iron levels. Urine color changes may need to be interpreted in conjunction with multiple clinical factors, clinical symptoms, and laboratory findings of acute iron poisoning.