Iron containing preparations are freely available. Many are brightly coloured, some with a sweet coating. Consequently, iron poisoning is not uncommon in children. Severe poisoning may result from the ingestion of more than 150 mg/kg. In small children, a dose of 20 mg/kg of elemental iron may cause illness and 600 mg may be fatal to a toddler weighing less than 10 kg (1).
Rapid necrosis of the gastrointestinal mucosa occurs, resulting in haemorrhage and fluid/electrolyte loss. The binding capacity of transferrin is finite, and saturation occurs rapidly as the iron is absorbed; the free serum iron level rises.
Severe poisoning is indicated by serum iron levels above 5 mg/l in a child, or 8 mg/l in an adult. It may be fatal.