The dangers of iron overload

Most health professionals know that iron overload can, after many years, lead to multiple organ failures, if not diagnosed and treated. Yet the messaging around over-consuming iron is often missed, with patient fears largely centred on the opposite scenario.

Thirty-eight-year-old mother of one Leslie Atkins* said she has been so worried about her nine-month-old’s iron levels being too low that she bolsters her iron-rich diet with iron-fortified foods.

“Everybody talks about it [the dangers of iron deficiency] — my doctor, mother’s group, friends, social media… everyone. […] I typically blend liver and spinach into a semi-liquid and give it to her [my daughter] after a formula feed. I also give her rice cereal with added iron,” she told Hospital + Healthcare.

Not helping matters, the guidelines around recommended iron intake can be confusing for parents. The recommended daily amount also fluctuates dramatically in short timespans of an infant’s development. For example, in Australia is it recommended that babies aged 7–12 months consume 11 mg of iron daily, while children aged 1–3 years are expected to drop to 8–9 mg.

Even well-informed parents may struggle to know what is best for their child, with national guidelines encompassing both haem- and plant-based iron — the latter of which is harder to absorb.

The guidelines also fail to take into account interactions iron has with other food groups. Some parents tend to believe they have minimal toxic potential. This could mean they inadequately safeguard them around the home, placing children at risk of accidental ingestion. They may also fail to tell their partner or co-parent about their children’s iron supplementation. In turn, prescribing doctors may not find out and offer drugs or supplements with harmful interactions.

While Australia is committed to the World Health Organization’s “Medication without Harm” initiative, much of its safety focus is on high-risk medications that form the APINCHS acronym (antimicrobials, potassium and other electrolytes, insulin, narcotics (opioids) and other sedatives, chemotherapeutic agents, heparin and other anticoagulants, and systems). With iron not recognised in the acronym, it may not receive adequate attention.

Senior Pharmacist of the Pharmaceutical Society of Australia Peter Guthrey believes technology and data could be key to resolving this and other paediatric medication errors.

“We can’t fix what we don’t measure effectively, so we need an all-of-system approach to tackling medication errors, particularly in paediatrics where patients are more vulnerable. This requires a blame-free recording culture to understand where we may be going wrong and to mitigate the risk of identified errors happening again […].

“We also need to see technologies like My Health Record becoming more ubiquitous. This could really help capture all information relating to a particular patient across more of the interactions they have with the healthcare system […].”

*name changed for privacy

Please consult a physician or a qualified health professional for personalised medical advice.

Image credit: iStockphoto.com/PhonlamaiPhoto