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In Reply.—We are pleased that Drs Banner and Czajka found our review comprehensive and thoughtful. With respect to their "closer consideration" of several points, we offer the following comments.
Clearly there must be some level of iron ingestion that is trivial, but we are unsure of what that level is. We advocate an approach that should be quite nontoxic in case an arbitrarily chosen level for concern is wrong. We await a more detailed presentation of the evidence for choosing 50 mg/kg as a useful guide. The Reissmann et al reference cited by Banner and Czajka does not substantiate the assertion that less than 50 mg/kg of iron is safe, even in animals.
Large fluid losses and poor tissue perfusion are tantamount to shock. We advocate the use of deferoxamine mesylate intravenously in the presence of shock.
Our support of the oral use of deferoxamine was not based primarily
LIETMAN PS, ROBOTHAM JL. Iron Poisoning-Reply. Am J Dis Child. 1981;135(5):485. doi:10.1001/archpedi.1981.02130290078030