Suicidal Iron and Paracetamol Overdose

A woman presented to a hospital complaining of drowsiness and body weakness. The patient reported intentionally ingesting about 30 ferrous sulfate tablets and about 10 paracetamol tablets after an argument with a loved one. The ingestion occurred within 24 hours of presentation to hospital. Blood samples taken before any treatment was given demonstrated severe metabolic acidosis, leukocytosis, and liver impairment with raised aspartate transaminase (244 U/L), alanine transaminase (140 U/L), alkaline phosphatase (130 U/L) and conjugated bilirubin (9 μmol/L), and an international normalized ratio of 4.61 seconds. Serum paracetamol levels more than 12 hours after ingestion confirmed paracetamol toxicity at 433 μmol/L (reference range, >264 μmol/L). Serum iron studies showed raised transferrin at 5.07 g/L (reference range, 2.50–3.80 g/L) and normal ferritin at 58 μg/L (reference range, 10–291 μg/L); however, serum iron testing was rejected due to insufficient specimens. The patient underwent treatment including iron chelation therapy with desferrioxamine and acetylcysteine therapy for paracetamol overdose. Later, an upper gastrointestinal bleed was suspected due to a rapid drop in hemoglobin level from 10.5 g/dL to 5.1 g/dL. Despite appropriate medical treatment and cardiopulmonary resuscitation, the patient died approximately 24 hours after admission.