Use of high doses of deferoxamine (desferal) in an adult patient with acute iron overdosage

Deferoxamine, a specific chelator of ferric iron, has recognized efficacy in the treatment of acute iron overdosage. Toxicological references, however, vary in the preferred route of administration and recommended maximum dosage. A 19-year-old female patient ingested an estimated 50-60 ferrous sulfate tablets, representing approximately 9.8-11.7 g of elemental iron. At the time of admission, she had a serum iron level of 915 μg/dL and a total iron binding capacity of 515 μg/dL. She was treated with intravenous deferoxamine at 15 mg/kg/h via continuous infusion for a total dose of 37.1 g over a 52-h period until her urine exhibited no evidence of deferoxamine-iron chelation products for 24 consecutive hours. This paper supports the safety and efficacy of a slow IV infusion of deferoxamine in an adult patient, using a regimen recommended for pediatric patients.