Chelation therapy with deferoxamine mesylate (DFO) may be indicated in patients with serious iron intoxication following ingestion of iron-containing medications.
Indications for chelation therapy:
(1) symptomatic patient with a history or signs of iron ingestion and showing more than transient minor symptoms such as passage of one soft stool or an episode of emesis
(2) presence of
(2a) lethargy and decreased mental status
(2b) abdominal pain
(2c) hypovolemia
(2d) acidosis
(3) presence of multiple radio-opacities due to iron pill fragments seen on abdominal X-rays
(4) serum level > 350 µg/dL and symptomatic
Conservative therapy recommended by Bosse (1995) if:
(1) serum iron < 500 µg/dL, AND
(2) either
(2a) asymptomatic, OR
(2b) self-limited non-bloody emesis or diarrhea without other symptoms
Therapy with desferoxamine usually consists of a continuous intravenous infusion of 15 mg/kg per hour.
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