Sir.—Although the review of iron poisoning offered by Drs Robotham and Lietman (Journal 1980;134:875-879) was comprehensive and thoughtful, several points regarding deferoxamine mesylate and lavage solutions deserve closer consideration. The authors suggest that "all patients arriving with a history of iron ingestion" be treated immediately with 2 g of intramuscular (IM) deferoxamine me-sylate. In cases with a reliable history of ingestion of less than 50 mg/kg of iron, animal data1 suggest a limited toxic potential. We have found this quantity to be a useful guide to identify those patients requiring early aggressive treatment in the absence of symptoms or other indications. For patients requiring deferoxamine, large fluid losses and poor tissue perfusion are common. In such a situation, treatment with IM deferoxamine would seem irrational. Intravenous administration is a more reasonable and reliable route for deferoxamine when it is clearly indicated.
The authors have supported the oral