Can you overdose on iron supplements?

One of the most common complaints you likely hear from your patients is that they feel tired or fatigued, even if they are getting enough sleep.

While this may seem mysterious at first, looking over their standard diet often reveals the culprit—not enough dietary iron. In fact, estimates are that as mush as a quarter of the world’s population is not getting enough dietary iron.

Given this number, it is prudent to test your patients for the possibility of iron deficiency and, should they test positive, recommend an iron supplement.

However, you should also be mindful of the potential for your patients to overdose on their iron supplements. They should understand that while iron supplements will help them overcome the symptoms of iron deficiency, taking too much can create its own serious health issues.

What happens when the body gets too much iron, what are the symptoms of an overdose, and how can it be treated?

How adequate iron intake helps the body

Iron is particularly crucial for building red blood cells as well as supporting their proper functioning. If your patients either do not have enough red blood cells (or those that do form are smaller than normal), they run the risk of anemia. The current Recommended Daily Allowance (RDA) values for iron intake for adults are:¹

Foods that are high in iron include lean meats and seafood, nuts, beans and fortified grain products. However, iron supplements provide higher amounts of dietary iron.¹

Symptoms of iron supplement overdose

Initial signs of iron overdose are usually nausea and abdominal pain but may also include diarrhea and vomiting blood.² These initial symptoms will usually begin within six hours of the overdose and then appear to improve after 24 to 48 hours. Unfortunately, after this initial phase, more serious symptoms can occur, including:²

• Jaundice
• Shock
• Low blood pressure
• Fast or weak pulse
• Headache
• Fever
• Shortness of breath
• Fluid in the lungs
• A grayish or bluish color in the skin
• Seizures

However, liver and cardiac failure are the biggest risks from an iron overdose.^2,3

Treatment of iron overdose

The first line of treatment is a procedure called whole bowel irrigation. This involves a solution that the patient swallows to rapidly flush out excess iron from the body.²

Another common treatment is chelation, involving a chemical that binds to iron to help it pass out of the body through the urine. Other treatments can include rehydration to treat diarrhea and vomiting, or breathing treatments if the lungs are affected.²

The easiest way for your patients to prevent an accidental iron overdose is to not double their daily iron supplement if they happen to skip one. Discuss with your patients the risks of accidentally overdosing on iron, as well as what they should do if they accidentally skip a dose.

References
¹ National Institutes of Health, Office of Dietary Supplements. “Iron” [Fact sheet]. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional. Updated Sept. 2018. Accessed Oct. 2018.

² O’Malley G, O’Malley, R. “Iron poisoning.” Merck Manual (Professional Version). https://www.merckmanuals.com/home/injuries-and-poisoning/poisoning/iron-poisoning. Updated Jan. 2018. Accessed Oct. 2018.

³ Abhilash KP, Arul JJ, Bala D. Fatal overdose of iron tablets in adults. Indian Journal of Critical Care Medicine. 2013;17(5):311-313.