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Iron is an element that is essential to our health. It is especially important for the proper functioning of our red blood cells, which carry oxygen. Iron is found in many foods and it is added to some fortified food products. It is also widely available as a supplement. Although iron is essential and is needed to maintain health, too much can lead to iron toxicity, which can be life-threatening.

Until the 1990s, iron poisoning was the leading cause of death from medicine overdoses in children younger than 6 years. Fortunately, there has been a steady drop in the number of serious iron poisoning cases since. This is because of better warning labels, education of prescribers, changes in the formulation and packaging of iron preparations, and consumer awareness of the dangers of iron poisoning.

Iron supplements are available over-the-counter or by prescription in a variety of forms: tablets, slow-release tablets, and liquids. Iron is often combined with many other minerals and vitamins and is a common ingredient in multivitamin preparations for adults and children. The iron content in these formulations vary greatly. Children's gummy or chewable multivitamins may not contain any iron at all. If they do, the iron content is typically very low. Adult multivitamins can contain a moderate amount of iron. The highest iron content is found in prenatal multivitamins. Adult and prenatal multivitamins with iron have been associated with the most serious poisonings in children.

Although death from iron poisoning is not as common today as it was prior to the 1990s, iron toxicity is still a threat, particularly among children. To kids, iron tablets look like candy. Toxicity is determined by the amount of iron taken per kilogram of body weight. Because of their small size, kids can quickly reach a toxic dose if they swallow adult or prenatal multivitamins because the iron content in each tablet is high. Serious poisoning sometimes happens in toddlers in a household with a new baby, because their mother had likely taken prenatal multivitamins. Given enough time, toddlers can open child-resistant closures (CRC) on medication bottles; nothing is really "child-proof." CRCs should be the last line of defense against unintentional poisoning among children.

Iron poisoning occurs because too much iron acts like a corrosive to the tissues lining the gastrointestinal tract, such as the stomach and intestines. This causes symptoms such as nausea, vomiting, abdominal pain, diarrhea and bleeding. These symptoms can quickly lead to excessive fluid and blood loss and, eventually, shock. Iron is also a cellular toxin; it damages and kills the cells that make up the tissues of our organs, like the liver. Iron toxicity can eventually lead to seizures, coma, multiple organ failure, and death.

Any overdose of iron-containing products should be taken seriously. Prompt treatment in the hospital can be life-saving. Fortunately, there is an antidote for iron poisoning and it can be given for serious cases. Unfortunately, the antidote itself is toxic at high doses, so prevention of iron overdoses is especially important.

To prevent unintentional iron poisoning:

Store all iron-containing supplements and multivitamins out of reach and sight of children.

Make sure to replace child-resistant closures tightly after each use. Although they are not child-proof, they help by slowing children down, giving parents and caretakers a little extra time to catch them in the act.

Always consult a health professional before taking any multivitamin or supplement.

Do not take more than one supplement containing one or more of the same ingredients prior to consulting your doctor.

Use the webPOISONCONTROL® online tool for guidance or call Poison Control at 1-800-222-1222 right away for guidance if someone swallows too much of any iron-containing medication. Whether you call or go online, you will need to answer some questions: age, weight, the amount swallowed, and whether the person is having any symptoms. If the amount taken is not expected to be poisonous, you'll be told what symptoms to watch for. If a potentially poisonous dose of iron is taken, you'll be referred to the closest emergency room.

Serkalem Mekonnen, RN, BSN, MPH

Certified Specialist in Poison Information