• Shannon S Rickner and Sing-Yi Feng.
• From the Division of Medical Toxicology, Department of Emergency Medicine.
• Pediatr Emerg Care. 2021 May 1; 37 (5): e269e271e269-e271.

AbstractCases of severe iron toxicity have become increasingly rare; most cases are intentional ingestions by late adolescents and adults who present within 12 hours of ingestion. We present a case of an adolescent girl with metabolic acidosis, hypoglycemia, obtundation, and liver and renal failure of undifferentiated etiology who was eventually discovered to have overdosed on ferrous sulfate tablets 4 days before arrival. The diagnosis was made because the patient had an elevated transferrin concentration in the setting of a minimally elevated serum iron concentration and faint radio-opacities on abdominal plain film imaging. This case presents many diagnostic challenges and treatment dilemmas and is a rare report of survival in delayed presentation of severe toxicity.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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