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Iron Poisoning — RACP Adult Medicine MCQ

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ModerateEmergency MedicineIron PoisoningRACP Adult Medicine

A 22-year-old woman presents 4 hours after ingesting 60 iron tablets. She has abdominal pain and bloody diarrhoea. Serum iron is 90 µmol/L (toxic >55 µmol/L). Abdominal X-ray shows radio-opaque tablets in the stomach. What is the specific antidote?

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Correct answer: D — Desferrioxamine (deferoxamine)

Desferrioxamine is the specific chelator for iron poisoning. It binds free iron forming ferrioxamine (excreted renally – causes characteristic vin rosé urine). Indications for desferrioxamine include: serum iron >90 µmol/L, significant GI symptoms, metabolic acidosis, or shock. Dose is 15 mg/kg/hr IV infusion (max 80 mg/kg/24 hrs). Activated charcoal does NOT bind iron. Whole bowel irrigation with polyethylene glycol may be considered for undissolved tablets seen on AXR.

Reference: eTG – 2025 – Toxicology