Abstract: TH-PO0465
Use of Extracorporeal Kidney Replacement Therapy in the Management of Acute Iron Poisoning with Multiple Organ Failure
Session Information
- Hemodialysis: Novel Markers and Case Reports
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Sudheer, Namitha, Methodist Health System, Dallas, Texas, United States
- Collazo-Maldonado, Roberto L., Methodist Health System, Dallas, Texas, United States
- Fa, Kosunarty, Methodist Health System, Dallas, Texas, United States
Introduction
In severe iron intoxication, kidney replacement therapy ( KRT) can be an effective treatment to help decrease serum iron concentration (SIC) and improve clinical status, when used in conjunction with other treatments like gastrointestinal decontamination and iron chelation using deferoxamine (DFO). Here, we present a case of successful use of KRT in treatment of iron intoxication.
Case Description
33 yo Hispanic woman with past medical history of PTSD presented with suicide attempt after taking 150 tablets of iron sulfate (9750mg of elemental iron). Iron level on presentation was 438 mcg/dl. She was started on N-acetyl cysteine and chelation with DFO which reduced Iron level to 265mcg/dl. But the patient continued to have worsening gastrointestinal symptoms, rise in total bilirubin to 2.5 from 0.3 mg/dl, AST to 5557 from 29U/l, ALT to 7686 from 20U/L and INR to 6.5 from 1.7 with no AKI. She was started on continuous venovenous hemo diafiltration due to hemodynamic instability and later on transitioned to HD. This reduced her Iron load to < 150mcg/dl and HD was stopped and showed improvement in clinical status and liver enzyme values.
Discussion
Acute iron poisoning is a common and potentially life-threatening situation. Ingestion of > 60 mg/Kg of elemental iron is associated with serious toxicity and death. DFO remains the primary antidote for iron toxicity, however KRT can be helpful in life-threatening situations where rapid iron reduction is necessary. DFO binds with ferric iron in the blood to form water soluble ferrioxamine which is renally excreted. Under physiological condition albumin bound % of iron is negligible and the volume of distribution equals plasma volume. KRT helps in removing excess while it is used in conjunction with DFO by removing iron- DFO complex more efficiently than the native kidneys. KRT is associated with better outcomes in severe iron toxicity and should be initiated when clinical deterioration and SIC is high, despite the administration of DFO.We report successful treatment of severe iron intoxication with KRT along with DFO. Extracorporeal renal replacement therapy should be considered in iron intoxication refractory to traditional management.