Pitfalls

Common errors in managing iron-toxic patients are many. The traditionally accepted indication of significant poisoning included a WBC of greater than 15,000/pL glucose level of more than 150 mg/dL, a 4-h serum iron level of more than 300 pg/dL, a serum iron level greater than TIBC, a positive deferoxamine challenge test, and a history of significant ingestion. However, reliance on iron levels and TIBC, WBC, serum glucose levels, and negative radiographs can lead physicians away from the proper diagnosis and increase time to treatment. Equating the so-called latent stage with clinical recovery when vital signs and clinical appearance are abnormal is an error in assessment and may lead to morbidity. Waiting for iron levels before beginning deferoxamine therapy is a misuse of time better spent aggressively caring for the patient. Withholding chelation therapy from a pregnant patient for fear of fetal toxicity from deferoxamine is not supported in the literature and should not occur.

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