Sorbifer Durules Overdosage

Symptoms: Acute iron overdosage can be divided into 4 stages.
Phase 1: Occurs up to 6 hours after oral ingestion, gastrointestinal toxicity, notably vomiting and diarrhea, predominates. Other effects may include cardiovascular disorders such as hypotension and tachycardia, metabolic changes including acidosis and hyperglycemia and CNS depression ranging from lethargy to coma. Patients with mild to moderate poisoning do not generally pass this first phase.
Phase 2: May occur at 6-24 hours after ingestion and its characterised by a temporary remission or clinical stabilisation.
Phase 3: Gastrointestinal toxicity recurs together with shock, metabolic acidosis, convulsions, coma, hepatic necrosis and jaundice, hypoglycemia, coagulation disorders, oliguria or renal failure and pulmonary edema.
Phase 4: May occur several weeks after ingestion and is characterised by gastrointestinal obstruction and possibly late hepatic damage.
Overdosage of ferrous salts is particularly dangerous to young children.
Treatment: Treatment consist of gastric lavage followed by the introduction of 5 g of desferrioxamine into the stomach. Serum iron levels should be monitored and in severe cases I.V. desferrioxamine should be given together with supportive and symptomatic measures as required. Gastric lavage with 5% sodium bicarbonate and saline catharthics (e.g. sodium sulfate 30 g for adults); milk and eggs with 5 g bismuth carbonate every hour as demulcents. Blood or plasma transfusion for shock, oxygen for respiratory depression. Chelating agents (e.g. disodium calcium edetate) may be tried (500 mg/500 mL by continuous IV infusion). Dimercaprol should not be used since it forms a toxic complex with iron. Desferrioxamine is a specific iron chelating agent and severe acute poisoning in infants should always be treated with desferrioxamine at a dose of 90 mg/kg I.M. followed by 15 mg/kg per hour I.V. until the serum iron is within the plasma binding capacity.