A toddler accidentally ingests ferrous sulfate tablets. The urine turns grey-green on treatment with deferoxamine. Which finding indicates systemic toxicity and mandates IV deferoxamine?

• A Serum iron level 200 mcg/dL at 4 hours post-ingestion
• B Abdominal pain alone in a fully conscious child
• C Vomiting within 1 hour of ingestion
• D Serum iron level >500 mcg/dL or symptomatic with shock/metabolic acidosis ✓

Explanation

IV deferoxamine is indicated when serum iron exceeds 500 mcg/dL or when clinical features of systemic iron toxicity are present: shock, altered consciousness, metabolic acidosis, or significant GI bleeding (phase II–IV toxicity). Mild GI symptoms with serum iron below 500 mcg/dL may be managed with supportive care. The vin-rosé urine from the ferrioxamine complex confirms deferoxamine effectiveness but is not itself the indication.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.