A 3-year-old is brought after ingesting multiple iron tablets. He is currently alert. Serum iron level at 4 hours post-ingestion is 390 mcg/dL. The correct management is:
- A IV deferoxamine infusion — serum iron >350 mcg/dL with symptoms indicates treatment ✓
- B Observe only; IV deferoxamine is indicated only if serum iron >500 mcg/dL
- C Oral activated charcoal and close monitoring
- D IV deferoxamine only when total iron binding capacity is exceeded
Correct answer: A. IV deferoxamine infusion — serum iron >350 mcg/dL with symptoms indicates treatment
Explanation
Deferoxamine is the chelating agent for iron toxicity. Indications include serum iron >350–500 mcg/dL or symptomatic toxicity (GI bleeding, shock, altered consciousness) regardless of level. This child at 390 mcg/dL warrants treatment even if currently alert, as the clinical course can deteriorate rapidly. Activated charcoal does not adsorb iron and is not useful. The TIBC is no longer used to guide treatment decisions.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.