An 18-month-old previous healthy girl who had ingested 442 mg elemental iron/kg was admitted to a paediatric intensive care unit. The child was treated with gastric lavage, whole bowel irrigation and intravenous deferoxamine. After 2 h of standard therapy serum iron had risen threefold to 1362 μg/dl (244 μmol/l). The child was treated with exchange transfusion (ET; 52 ml/kg) and serum iron fell to 134 μg/dl (24 μmol/l). The patient made an uncomplicated recovery. ET should be considered in severe iron poisoning when standard therapy is inadequate.
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Competing interests: None.
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