A 3-year-old is brought to the emergency department 30 minutes after accidentally ingesting iron tablets (estimated 40 mg/kg of elemental iron). Which of the following features would MOST warrant immediate chelation therapy with deferoxamine?
- A Serum iron 200 mcg/dL with mild nausea
- B Serum iron 550 mcg/dL with shock, altered consciousness, and metabolic acidosis ✓
- C Serum iron 350 mcg/dL with vomiting only
- D Ingestion >20 mg/kg with serum iron 280 mcg/dL
Correct answer: B. Serum iron 550 mcg/dL with shock, altered consciousness, and metabolic acidosis
Explanation
Deferoxamine chelation is indicated in iron poisoning when serum iron exceeds 500 mcg/dL, or when severe systemic toxicity is present (shock, coma, metabolic acidosis) regardless of serum level. Option B shows both a very high serum iron level and life-threatening systemic features, making it the clearest indication. Serum iron between 350–500 mcg/dL with only mild symptoms can be managed with supportive care and close monitoring.
Reference: Ghai Essential Pediatrics, 10th ed.
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