radiograph also suggests potential for significant absorption of iron ( Fig 102.3 ) Measurement of the total iron-binding capacity is no longer useful in acute management With these observations in mind, it is possible to construct a protocol for the triage and initial management of the patient who has ingested a possibly toxic amount of iron ( Fig 102.4 ) The treatment for acute iron poisoning includes efforts to decrease absorption and hasten excretion Most children with toxic iron exposures will exhibit spontaneous vomiting Activated charcoal is not effective in binding iron salts For serious poisonings, gastric lavage with normal saline can be considered in patients who present early after liquid iron ingestion, in the hope of minimizing any direct mucosal injury caused by residual particulate matter and possibly contributing to the dissolution of pill concretions