Exhange transfusion: the removal of iron-poisoned blood is ery old-school, but it works ( Movassaghi et al, 1969). Surgical removal of tablets - if a bezoar is clearly visible on the AXR. Whole bowel irrigation - until effluent turns clear - is a good strategy much of the toxicity is related to gut ulceration, and by diluting the iron in the gut lumen you may be able to ameliorate this direct corrosive effect, even if you don't manage to prevent toxic absorption. Management of iron toxicity Decontamination Stage IV: GI scarring (4-6 weeks since ingestion) - gastric scarring and pyloric stricture. Stage III: mitochondrial toxicity and hepatic necrosis (12-48 h since ingestion)- acute liver failure, coagulopathy, acute tubular necrosis, metabolic acidosis and shock. Stage II: "apparent stabilization" (6-12 h since ingestion) - symptoms subside. Stage I: GI toxicity (0-6 h since ingestion): vomiting, haematemesis, abdominal pain and lethargy. Minor contribution from iron itself (conversion of Fe 3+ to Fe 2+ produces a net loss of a cation, and therefore contributes to the decrease in the SID). Acute cerebral oedema due to liver failure. Cardiotoxic effects, with cardiogenic shock. Blood and fluid loss from the ulcerated gut. Renal toxicity is partly due to shock, and partly due to direct toxicityĬlinical features of iron toxicity Feature. Hepatotoxicity is partly due to shock, and results in coma, coagulopathy and hyperbilirubinaemia. Acidosis is multifactorial (see above) but is mainly lactate-driven, due to mitochondrial toxicity. Shock is due to fluid loss into the gut. 
Abdominal pain, nausea and vomiting is the result of the directly corrosive effect of iron.I will reproduce the diagram here, for convenience. The mechanisms of high anion gap metabolic acidosis due to iron poisoning are presented elsewhere. Question 8 from the second paper of 2013 and the identical Question 18 from the second paper of 2009 both present the candidates with a paediatric scenario of iron overdose.The paediatric component takes a backseat, and the dominant flavour of the questions is pure toxicology.
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