What is the role of serum iron measurement in the diagnosis of iron toxicity?

Updated: Feb 04, 2019
  • Author: Clifford S Spanierman, MD; Chief Editor: Michael A Miller, MD  more...
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For serum iron measurement, samples should be drawn at least 4 hours postingestion, to allow levels to reach steady state; however, levels drawn more than 6 hours after ingestion may underestimate toxicity because of ferritin binding and redistribution of iron. The significance of results is as follows:

  • In adults, levels may not correlate well with the clinical presentation

  • Mild-to-moderate toxicity generally manifests at levels of 350-500 mcg/dL

  • Persistently symptomatic patients with serum iron levels higher than 350 mcg/dL should be admitted

  • Hepatotoxicity usually is observed at levels higher than 500 mcg/dL

  • Levels higher than 800 mcg/dL are associated with severe toxicity

  • Patients with serum iron levels higher than 1000 mcg/dL should be in a facility that can provide age-appropriate intensive care

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