Acute iron intoxication: a case report with ferric chloride ingestion

A 24 y/o male, after attempting suicide by ingesting liquid ferric chloride, presented with protracted vomiting and epigastric pain. He was noted to have leukocytosis, a metabolic acidosis and an elevated serum iron level. Hemorrhagic gastritis, coagulation defects and an increase in urine beta 2-microglobulin, indicating renal tubular damages were found in the following day. He later recovered after treatment with deferoxamine and good supportive care. This is Taiwan's first reported case of acute iron intoxication in an attempted suicide. We discussed the characteristics of this liquid form of iron intoxication, the limitations of local laboratories in providing support and how to diagnose and treat acute iron intoxication without waiting for serum iron and total iron binding capacity levels. In conclusion, to evaluate the severity of iron intoxication, a deferoxamine challenge test and the severity of symptoms and signs should be assessed without relying only on serum iron and total iron binding capacity levels. Deferoxamine and good supportive care should be given to all serious iron intoxications.