Similar to most exposures, larger ingestions are more likely associated with greater toxicity. However, it is the amount of ingested elemental iron that determines a patient's potential for experiencing toxicity. Since the fraction of elemental iron varies with different preparations, it is important to determine which of these was ingested. These fractions may range from 12 to 33 percent, with ferrous sulfate containing 20 percent elemental iron (e.g., a 325-mg tablet of ferrous sulfate contains 60 mg of elemental iron). Pediatric multivitamins may contain from 10 to 18 mg of elemental iron per tablet. Toxic effects have been reported following oral doses as low as 10 and 20 mg/kg elemental iron.
In general, moderate toxicity occurs at doses of 20 to 60 mg/kg, and severe toxicity can be expected following doses of greater than 60 mg/kg. 4 These guidelines can be useful in predicting potential toxicity based on the history of ingestion. The majority of exposures, however, involve children under age 6, who mostly remain asymptomatic or develop only minimal toxicity.
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