Polysaccharide iron complex ingestions reported to a regional poison centre: a retrospective review 2011-2023

Clin Toxicol (Phila). 2026 Jul 21:1-9. doi: 10.1080/15563650.2026.2696435. Online ahead of print.

ABSTRACT

INTRODUCTION: Polysaccharide iron complex is a widely used iron supplement with a high elemental iron content. Despite a reported lethal dose 50 (LD50) significantly higher for polysaccharide iron complex than for iron salts (ferrous fumarate, ferrous sulfate, ferrous gluconate), commonly used poison centre reference databases such as Micromedex^® and Toxinz^® do not differentiate between polysaccharide iron complex and other iron formulations for the emergency department referral threshold (40 mg/kg elemental iron). The purpose of this study is to review polysaccharide iron complex exposures reported to a poison centre for clinical outcomes.

METHODS: We performed a retrospective review of polysaccharide iron complex calls to a regional poison centre between 2011 and 2023. The poison centre electronic database Visual Dotlab was searched for records encoded with America’s Poison Centers^® Generic Code^® “23000” as well as for substances documented as: “Iron”, “Polysaccharide”, and “Feramax^®“. Cases with a co-ingestion of other iron salts were excluded. Records were individually reviewed for details of ingestion amount, symptoms, management recommendations, medical outcome, and serum iron concentrations.

RESULTS: The search yielded 219 cases of polysaccharide iron complex ingestions. The median elemental iron ingestion amount was 300 mg (range 45-14,250 mg; IQR 150-750 mg) or 12.7 mg/kg (n = 193) when patient weight was available (range 1.7-225 mg/kg; IQR 6-26.4 mg/kg). The majority (161/219) of the cases were below the 40 mg/kg threshold, with 32/219 above that threshold. All 170 unintentional ingestions and 41/49 (84%) intentional ingestions sustained “No” or “Minor” effects despite intentional ingestions having significantly higher ingestion amounts. “Moderate” and “Major” effects were only documented in intentional ingestions with co-ingestants. Serum iron concentrations were recorded for 39 cases, with the highest at 75 µmol/L (56.6 mg/kg ingestion), and 70 µmol/L (225 mg/kg ingestion); both were polyingestions with suicide intent. None of the patients required treatment with deferoxamine based on serum iron concentrations or symptoms.

DISCUSSION: This study demonstrates that unintentional polysaccharide iron complex ingestions are benign, with larger ingestions (up to 225 mg/kg), including intentional ingestions, having minimal toxicity.

CONCLUSIONS: Polysaccharide iron complex appears to have low toxicity, suggesting that poison centres may consider modifying recommendations to reflect the lower toxicity potential for polysaccharide iron complex ingestions.

PMID:42480044 | DOI:10.1080/15563650.2026.2696435