Efficacy of orally administered deferoxamine, activated charcoal, and sodium bicarbonate in acute iron intoxication in rats: Implications for the treatment of pediatric iron poisoning

Background: Iron supplements are the most, frequent; cause of pediatric fat alities from unintentional ingestion. The ability to prevent iron absorptio n from the digestive tract is limited. Although activated charcoal (AC) alo ne does not absorb iron, the oral administration of deferoxamine (DFO) and AC has been shown to reduce iron absorption in human volunteers. In the pre sence of sodium bicarbonate (NaNCO3), ferrous iron is oxidized to ferric ir on. Therefore, the coadministration of DFO, AC, and NaHCO3 may enhance ente ral iron chelation. Objective: The purpose of the study was to determine whether the oral admin istration of DFO and AC, with or without NaHCO3, can reduce iron absorption from the digestive tract. Methods: In a rat model of acute iron overloading, Ferrous sulfate (FeSO4) 100 mg/kg body weight was administered by gavage, followed by DFO 150 mg/kg , AC 500 mg/kg, and NaHCO3 1 mEq/kg. Results: The administration of FeSO4 100 mg/kg increased serum iron concent rations to >350 mu g/100 mt. Oral dosing with DFO and AC (separately and si multaneously, immediately or after 10 to 20 minutes) did not prevent iron a bsorption from the digestive tract. Subsequently, however, DFO significantl y decreased the elevated serum iron concentrations (P < 0.05), probably by chelating the already absorbed iron. Coadministration of NaHCO3 further dec reased (P < 0.01) the serum iron concentration. Conclusions: Although orally administered DFO and AC do not prevent iron ab sorption from the digestive tract, DFO does increase the rate of iron excre tion from the body, and NaHCO3 enhances this effect.