A fatal case of iron toxicity in an adult
Acute iron toxicity is usually seen in children with accidental ingestion of iron-containing syrups. However, the literature on acute iron toxicity with suicidal intent in adults is scant. Published in the Indian Journal of Critical Care Medicine, the authors report an instance wherein an adult committed suicide by ingestion of multiple iron tablets.

Delay in treatment was there due to misdiagnosis of the intoxicating agent. She developed fulminant hepatic failure with rapid clinical deterioration. Despite aggressive supportive management, the patient succumbed to the toxic doses of iron. Clinical course and postmortem features are discussed with a review of the literature.

A 20-year-old female allegedly consumed some tablets with suicidal intention. She initially presented at primary health center with abdominal pain, vomiting, diarrhea, and shock. As the intoxicating agent was not clear, treatment was started for aluminum phosphide poisoning as it is quite prevalent in the area. Initial complete blood count and serum electrolytes were unremarkable. The patient's condition deteriorated and she was referred to our hospital on the 3rd day.

Prothrombin time was 56 with international normalized ratio of 5.7. Silver nitrate test was negative for phosphide. Her detailed history was sought again, in which she revealed consumption of many ferrous sulfate tablets. Hematic profile showed serum iron levels as 185 μg/dl, serum ferritin – 692 ng/dl, total iron binding capacity – 90 μg/dl, and percentage saturation – 2%.

Blood gas analysis revealed severe metabolic acidosis. Chelation therapy with desferrioxamine was started, and supportive measures were continued. However, her clinical condition deteriorated further, and she died within 48 h of admission due to multiorgan failure.

Autopsy revealed enlarged liver. Histopathology demonstrated periportal necrosis and bile cholestasis. Other organs were unremarkable on routine hematoxylin and eosin stain. On Perl's stain, iron deposits were noted in the liver, lungs, and spleen, suggestive of iron overload. Cause of death was attributed to multiorgan failure due to iron poisoning.

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