Management

Seek expert advice.

The mainstay of treatment is desferrioxamine, a chelating agent which is effective both orally and parentally.

Stages:

• empty stomach immediately - by gastric lavage, preferably with sodium bicarbonate as the lavage solution, or in children, by emesis
• desferrioxamine - 5 g in an adult, or 2 g in a child, in 50 ml of water to be left in the stomach
• follow with oral milk
• monitor haemoglobin and serum iron at 4 hr
• if serum iron greater than 5 mg/l in a child or greater than 8 mg/l in an adult, OR, patient is shocked, drowsy or comatose, irrespective of serum iron level, then
  • commence i.v. desferrioxamine infusion at a rate not exceeding 15 mg/kg/hr to a maximum of 80 mg/kg in 24 hr
  • otherwise, give desferrioxamine 2 g i.m.
• monitor progress with serial serum iron level measurements

The effectiveness of treatment depends on adequate renal function. If the patient is oliguric or anuric then i.v. desferrioxamine becomes unsafe, and peritoneal- or haemo- dialysis is indicated.