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Iron overdose — SCE Acute Medicine MCQ

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HardToxicology and OverdoseIron overdoseSCE Acute Medicine

A 55-year-old man presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show shock, acidosis and radiopaque iron tablets after ingestion. What is the most appropriate next step in management?

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Correct answer: E — Start intravenous desferrioxamine and consider whole-bowel irrigation

The key discriminator is that shock, acidosis and radiopaque iron tablets after ingestion, which makes Start intravenous desferrioxamine and consider whole-bowel irrigation the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Start broad-spectrum intravenous antibiotics would fit a different presentation or later stage of care. Provide supportive care and close monitoring and Give controlled oxygen and senior review are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; BNF desferrioxamine