Case Report

Acute Liver Failure Due to Iron Overdose in an Adult

Authors: Sumanth R. Daram, MD, Paul H. Hayashi, MD

Abstract

The vast majority of acute iron toxicity cases occur in children less than 5 years of age. Moreover, clinical hepatic injury is uncommon with most symptoms stemming from the intestinal tract (eg, nausea, vomiting, diarrhea). Therefore, physicians, particularly those who do not routinely treat pediatric patients, are often unfamiliar with hepatotoxicity related to iron overdose. Nevertheless, hepatotoxicity caused by acute iron poisoning is associated with a high mortality rate. We report a case of severe hepatic injury in an adult who overdosed on iron tablets with suicidal intent. Tests for other hepatotoxins (eg, acetaminophen), hepatatrophic viruses, and other causes of acute liver injury were negative. Although peak serum iron level (340 μg/dL) was significantly lower than that reported to cause hepatotoxicity (>1,700 μg/dL), rapid and significant elevations in aminotransferases (>4,000 U/L), total bilirubin (5 mg/dL), and prothrombin time (50 seconds) occurred within 48 hours. Treatment with deferoxamine was prompt and followed by empiric N-acetylcysteine once liver injury was apparent. The patient was minimally symptomatic and she eventually had a full recovery.


Key Points


* Acute liver failure from iron overdose is unusual in children and rare in adults.


* Peak serum levels of iron may not predict hepatotoxicity.


* One should monitor liver enzymes, bilirubin, international normalized ratio, and mental status in all iron overdose cases.


* Deferoxamine and early referral to a liver transplant center remain mainstay interventions.

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