Decontamination

Gastrointestinal decontamination with activated charcoal has no role in the management of iron poisoning because iron does not bind to charcoal.

Either whole bowel irrigation or endoscopic removal may be indicated for iron poisoning in patients who have radio-opaque tablets visible in the gut on abdominal X-ray.

If a large number of radio-opaque tablets are visible in the stomach on abdominal X-ray after a massive iron ingestion (more than 120mg/kg of elemental iron), refer the patient for an endoscopy to attempt removal.

If a substantial number of radio-opaque tablets are visible in the gut on abdominal X-ray after a toxic amount of iron has been ingested (more than 60 mg/kg of elemental iron), consider whole bowel irrigation if it has been less than 4 hours since ingestion.

Iron poisoning is often associated with nausea and vomiting, which may make whole bowel irrigation difficult to administer. Patients must be able to protect their airway or be intubated to undergo whole bowel irrigation. If the patient is intubated, the whole bowel irrigation preparation is given via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.

Discuss the need for whole bowel irrigation and which preparation to use (see Examples of macrogol 3350 (with electrolytes) preparations used for whole bowel irrigation) with a clinical toxicologist. Do not initiate whole bowel irrigation in a patient at significant risk of pulmonary aspiration or with established ileus. During treatment, examine patients hourly for signs of ileus, in particular increasing abdominal distension.