Conservative management of patients with moderately elevated serum iron levels

For the four year period 1990-1993, we retrospectively reviewed all cases of iron ingestion reported to a regional poison control center that had serum iron levels in the 300-500 micrograms/dL range and did not receive deferoxamine. A total of 32 patients did not undergo deferoxamine therapy or challenge testing. The mean age was 6.7 years (range five months to 21 years). The mean serum iron level was 372.8 micrograms/dL (range 301-487 micrograms/dL). Ten patients (31.3%) were asymptomatic. Symptoms included vomiting in 18 (56.3%), diarrhea in six (18.8%), lethargy in one (3.1%), and transient hypotension in one patient (3.1%). No patients presented with grossly bloody emesis or stool. Fifteen patients (46.9%) were hospitalized for at least one day. Seventeen (53.1%) were treated and released from the emergency department. All 32 patients recovered without sequelae. A conservative approach without deferoxamine therapy or challenge should be considered when serum iron levels are in the 300-500 micrograms/dL range in asymptomatic patients, as well as in those with self-limited, non-bloody emesis or diarrhea without other symptoms.