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This includes your doctors, nurses, pharmacists, and dentists. If you find your child among iron pills or pill containers, or your child tells you they swallowed pills, take the child to a hospital's emergency department. In 2021 we had over 1.2 million pills, and this last year we had over 1.4 million pills come into my community." All potential risks should be taken into account. Side effects of an iron infusion can include nausea, vomiting, diarrhea, dizziness, headache, flushing, or feeling hot. Philadelphia, PA: Elsevier; 2022:chap 24. Creative Ways To Customize Your Badge Reels, Top Supply Chain And Logistics Trends In 2023, How To Quiet Noisy Lifters And Keep Your Workouts On Track. The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Toxic effects begin to occur at doses above 20 mg/kg of elemental iron. WebMost healthy adults get all the iron they need from the food they eat and don't need supplementation. The doctor may draw blood from your child to determine these levels: The doctor may also ask for an X-ray of your childs abdomen to confirm whether there are iron pills in the gastrointestinal tract, although sometimes the pills can be there and not seen. 16th ed. Allergic reactions to the infusion can also cause itching, raised bumps, hives, or swelling, and in rare cases, anaphylactic shock. Whole bowel irrigation with a special solution to quickly flush the iron through the stomach and intestines (taken by mouth or through a tube through the nose into the stomach). Given this number, it is prudent to test your patients for the possibility of iron deficiency and, should they test positive, recommend an iron supplement. You should call if you have any questions about poisoning or poison prevention. Treatment for iron poisoning involves providing fluid replacement, gastrointestinal decontamination, administering deferoxamine intravenously, liver transplants, and monitoring the patient's condition. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 1 National Institutes of Health, Office of Dietary Supplements. privacy practices. The more quickly the person receives treatment, the better the chance for survival. Do not start, stop, or change the dose of For adults and children ages 14 and up, the upper limit -- the These include: Acute iron poisoning happens when people overdose on iron supplements. Theobald JL, Mycyk MB. Waltham, MA: Elsevier; 2016:323-333. It is a crucial part of hemoglobin, a protein found in red blood cells. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. That's equal to 4,000 milligrams (mg), or about eight extra-strength (500 mg) tablets. WebDid you take 6,570 mg (6.6 g) of elemental iron or 65.7 mg (100 tablets x 0.657 mg)? Just For instance, ferrous sulfate is available as drops, syrup, elixir, capsules, and tablets. Water-soluble vitamins are most effective when you take them with water on an empty stomach. Talk with the doctor. During this phase, metabolic acidosis may also develop damaging internal organs such as the brain and liver. The most ideal way would be to eliminate the risks of such accidents occurring in the first instance. Our bodies have opioid receptors in different parts such as the central and peripheral nervous system, brain, as well as the gastrointestinal tract. Review/update the According to the Institute of Medicine, most adults can consume up to 45 milligrams of elemental iron daily without toxicity occurring. Call your doctor for medical advice about side effects. 's editorial policy editorial process and privacy policy. 16th ed. Iron pillscan look like candy to children. Make sure that you do not combine drugs without the guidance of a doctor. Symptoms include, ( this is not a complete list). Call 911 for all medical emergencies. Minerals in general you have to be more careful with than vitamin supplements. It could be 3 or more in a situation where it is recommended you take 2 pills. Be ready to tell or show what was You can call for any reason, 24 hours a day, 7 days a week. This is called 'chelation.'. When Is the Best Time of Day to Take Iron Supplements? If you have an allergy to any part of this medicine (iron tablets and capsules). Healthline Media does not provide medical advice, diagnosis, or treatment. [4] recommended duration of treatment is until symptoms have resolved which is usually 24 hours. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Could you tell me what happens if you take 20 tylenol (acetaminophen) and ibuprofen pills. Iron supplementation is another story. Generally, one should not take more than 4g/day of all, ) sources (assuming your liver is normal - less, if abnormal). For example, a 300 mg tablet of ferrous fumarate will contain 100 mg of elemental iron or 33%. Children are at particular risk of iron poisoning (overdose), making it very important to store iron tablets out of the reach of children. Some products have tartrazine. Clinical presentation of iron poisoning in the absence of treatment progresses in five stages: the gastrointestinal phase, latent phase, metabolic acidosis and shock phase, hepatotoxicity phase, and bowel obstruction due to scarring. Depressants which affect the human central nervous system include alcohol an opioids. Iron supplements are generally safe if taken as advised by your doctor, and the dosage varies depending on how severe your condition is. In: McPherson RA, Pincus MR, eds. WebYes, it is possible to feel sick after receiving an iron infusion. Ingestions of more than 60 mg/kg of Symptoms of iron poisoning usually become evident within 6 hours after an excessive amount of iron is swallowed. A child may show no symptoms after eating a number of pills that might have looked like candy. Gradually, the excess iron accumulates in internal organs, causing potentially fatal damage to the brain and liver. Toxic effects begin to occur at doses above 10-20 mg/kg of elemental iron. Indian Journal of Critical Care Medicine. Individuals may present with signs of cardiogenic shock indicated by low blood pressure, rapid heart rate and severe shortness of breath. One of the easiest substances to overdose on is opioids, this is mainly because of the way they function the moment they are consumed. [5] Hypovolemic shock occurs due to loss of blood from the gastrointestinal bleeding caused by the iron. Rosen's Emergency Medicine: Concepts and Clinical Practice. More often than not, this information is not often available. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. WebIron is a mineral found in many over-the-counter supplements. Do not store in a bathroom. If you're not getting enough iron, you may develop iron-deficiency anemia. You may report side effects to the FDA at 1-800-FDA-1088. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. WebHow many pills would it take exactly to overdose? If you are allergic to this medicine (iron tablets and capsules); any part of this medicine (iron tablets and capsules); or any other drugs, foods, or substances. For most people, iron overload is not a concern. Not just Tylenol. There is no doubt that iron overload may lead to cancer in both animals and humans (15, 16). Last updated on Oct 9, 2022. All rights reserved. In mild to moderate cases, individuals may be asymptomatic or only experience mild gastrointestinal symptoms that resolve within six hours. All rights reserved. For this reason, the total milligrams or dosage of an iron supplement you can take before toxicity occurs depends on the form of iron in your supplement. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, Aspirin and Other Drugs That May Trigger Asthma. Click here for an email preview. Higher CFU counts do not necessarily improve the products health effects. A.D.A.M. Dark stools. Also, the severity of such an overdose is subject to the drug, the volume taken and the medical history of the person that took the drug. [4] Free iron in the blood is toxic to the body as it disrupts normal cell function, damaging organs such as the liver, stomach, and cardiovascular system. is very hard on your liver and chronic long term use of this product can damage the liver. Iron overdose can be very severe in children. WebIt is unlikely to get iron poisoning from diet alone with iron supplements being the cause of overdose. People who get little or no heme iron in their diet are at an increased risk of iron deficiency (3, 4). [3] Measuring electrolyte levels, kidney function, serum glucose, liver function tests (enzymes and bilirubin), complete blood count, clotting time via prothrombin and partial thromboplastin time, anion gap for metabolic acidosis, should be conducted for clinical monitoring and confirmation of iron poisoning. The immune system uses iron to kill harmful bacteria, so some amount of iron is needed to fight infections. information submitted for this request. In rare cases, overdoses can be fatal. Ferrous sulfate overdose; Ferrous gluconate overdose; Ferrous fumarate overdose. Meyler's Side Effects of Drugs. In short, iron can be dangerous in high quantities. Keep all drugs in a safe place. Convulsions, excessive sweating, increasing pulse, stroke, cardiac malfunction, and hypertension are some of the other symptoms. Generic name: Iron Tablets and Capsules [EYE-urn] It may be given to you for other reasons. People with iron poisoning can have the following symptoms: Often, after supportive care, the gastrointestinal symptoms appear to improve within 6 to 24 hours after their onset. If stomach upset occurs, you may take this medication with food. In 2020 we had over 200,000 pills. However, several iron overload disorders may disrupt this fragile balance. Aronson JK. This site complies with the HONcode standard for trustworthy health information: verify here. Depends: Generally, one should not take more than 4g/day of all tylenol ( acetaminophen) sources (assuming your liver is normal - less, if abnormal). At high doses, iron is toxic. Vegetarian Foods That Are Loaded With Iron, 7 Nutrient Deficiencies That Are Incredibly Common, Iron Deficiency Anemia Secondary to Inadequate Dietary Iron Intake, Glycemic Index: What It Is and How to Use It, Iron is an essential nutrient that plays a role in many basic body functions, so we must get a, High levels of iron are potentially toxic, so we should avoid getting. Here is a breakdown of some: Adults may overdose on a drug if they fail to adhere strictly to the prescribed instruction. Anemia is caused by a lack of iron in your body. Amounts It is when these safety mechanisms fail that health issues arise. This is a free and confidential service. An 8-year-old may show no symptoms from an amount that would cause serious symptoms in a 3-year-old. It should be noted that different opioids could be quite severe. If you want to take iron supplements, talk to your doctor about finding the proper dosage for you. There are however some medications that can be used to lower the effects and stabilize the vital signs such as respiratory irregularities. It would also slow the rate of breathing and heart rate. Probiotics are measured in colony forming units (CFU), which indicate the number of living cells of microbes. convulsions (seizures) pale, clammy skin. A sound human body should ordinarily be able to handle a unit of pure alcohol for each hour which is equivalent to the alcohol in a half-pint of beer. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. If they however overdose and no one is around, they may have to recover alone at home. A severe overdose can happen if a child eats adult multivitamins, such as prenatal vitamins. However, many people have no side effects or only have minor side effects. [4] Systemic signs and symptoms shown in serious toxicity occur at higher doses exceeding 60mg/kg. Here are 7 incredibly common nutrient deficiencies. You may opt-out of email communications at any time by clicking on Endoscopy -- camera and tube placed down the throat to view the esophagus and the stomach and to remove pills or stop internal bleeding. Our daily requirement for Iron depends on several factors; Women of child-bearing age have the highest need for Iron, with a daily requirement of 14.8mg. delivered to your home or office. Ferrous iron is then absorbed in the small intestine where it is oxidized into its ferric iron (Fe3+) form before being released into the bloodstream. If you take too much of something on purpose, it is called an intentional or deliberate overdose. This indicates that about 700,000 overdoses Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. One thing about kids is that they can be pretty curious beings and will always want to put things in their mouths. Henry's Clinical Diagnosis and Management by Laboratory Methods. This happens more when there is a case of addiction. Speak with your healthcare provider to determine the right dose for you. This leads to the build up of iron in tissues and organs (13). Also, make sure that you do not mix prescription drugs and alcohol without first asking your doctor. In fact, iron is so toxic that its absorption from the digestive tract is tightly controlled. Get Chiropractic Economics magazine For patients at a high risk of infection, iron supplementation should be a well-grounded decision. Iron is an essential dietary mineral that plays an important role in transporting oxygen throughout the body. Never disregard or delay professional medical advice in person because of anything on HealthTap. Iron overdose is particularly WebIt is best to space doses of these 2 products 1 to 2 hours apart, to get the full benefit from each medicine or dietary supplement. WebFentanyl and Overdose Fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths. However, when an excessively high dosage of these drugs is taken, it could cause certain side effects such as overdose, respiratory failure, and even outright death. The body has no easy way to dispose of extra iron. 2 OMalley G, OMalley, R. Iron poisoning. Merck Manual (Professional Version). Ethnocentrism And Cultural Relativism: Things You Should Know. However, like many other nutrients, it is harmful in high amounts. You should also know that taking some drugs may be riskier than others. Laboratory tests such as measuring the peak serum iron level after 4 to 6 hours of ingestion can be useful in determining the severity of iron toxicity. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. It is caused by the bodys regulatory system failing to keep iron levels within healthy limits (12). If this medicine (iron tablets and capsules) is taken by accident, call a doctor or poison control center right away. You can take 1000 mg at a time up to four times in a day. However, your body requires minimum levels of iron to maintain red blood cell production and oxygen transport and to prevent anemia. Some people have died up to a week after an iron overdose. Some 4-6 weeks after ingestion, the final stage manifests with early satiety (fullness after eating) or nausea from GI scarring and obstruction. Drug class: Iron products. There is also a large number of people who are victims of nonlethal overdoses each year. Kids have a higher chance of suffering from an accidental drug overdose if they are not properly monitored. Over time, diets low in iron may cause a deficiency. WebSo it could take as little as 1 pill to more than you're physically able to ingest, but that also also means swallowing 100 pills could result in only a mild stomach ache or even no symptoms at all. Theobald JL, Kostic MA. Many probiotic formulations have billions of CFUs per serving, some containing 1 to 10 billion CFUs per dose, while others contain up to 50 billion or more. In this situation, it could take some minutes for a person who just took it to feel the full effects. Depending on the severity of the overdose, the severe symptoms may occur anywhere between 12 hours Keep Toxicology and therapeutic drug monitoring. In normal physiologic conditions, nonionic forms of iron (Fe) are converted into ferrous iron (Fe2+) by gastric acid in the stomach. [2] If left untreated, iron poisoning can lead to multi-organ failure resulting in permanent organ damage or death. You need to contact the poison control center nearest you (1-800-222-1222) and/or take her to the emergency room immediately. The Centers for Disease Control and Prevention began seeing fentanyl-related overdose deaths rise in 2012. Tell your doctor if you are pregnant or plan on getting pregnant. [1][2] Overdoses on iron can be categorized as unintentional ingestion which is predominantly associated with children or intentional ingestion involving suicide attempts in adults. Bring the medicine containers along with you to the hospital. Created for people with ongoing healthcare needs but benefits everyone. Updated Jan. 2018. The easiest way for your patients to prevent an accidental iron overdose is to not double their daily iron supplement if they happen to skip one. In most cases, the healthcare provider may be able to deploy antidotes for certain cases of overdose. By using our website, you consent to our use of cookies. including two annual Buyers Guides. If you suspect your child has accidentally swallowed iron tablets, call your doctor or poison control center immediately. Symptoms will be treated. The most common disorder is hereditary hemochromatosis, which may lead to many health problems. Educate your children that unknown pills are not candy and can be harmful. This is why you should take great care to ensure that you do not overdose on any type of drug. Can you let me know how many tylenol (acetaminophen) pain reliever pills does it take to overdose? WebToo many iron supplements can cause long-term side effects like liver damage and heart disease. Here are 21 iron-rich plant foods for vegetarians and vegans. A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). They could also insert a breathing tube when there is a perceived problem with breathing. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. [4] In children, signs of shock can be noted with behavioral changes such as decreased responsiveness, crying, and inability to focus. This national hotline will let you talk to experts in poisoning. Aronson JK. A severe overdose can happen if a child eats adult 1. Children may sometimes eat large amounts of iron pills because they look like candy. Many manufacturers have changed their pills so they no longer look like candy. Similarly, repeated high-dose iron supplementation may cause serious problems. Orogastric lavage, or pumping of the stomach, may be considered. Intentional overdose can occur among adults, but is rare. Your health care provider may recommend Iron overdose can be very severe in children. WebAs iron builds up in the organs, symptoms begin to get more severe. Read more: Iron-Rich Foods for Iron Deficiency and Anemia. This medicine works better if you take it on an empty stomach. The more quickly the person receives treatment, the better the chance for survival. Philadelphia, PA: Elsevier; 2020:chap 77. When a person uses opioids, the receptors outlined will become activated and as such slow down the body. 2005 - 2023 WebMD LLC. Deferoxamine can be administered by IV or shot, but the IV route is preferred for easier dose adjustment. For instance, if you have kids in your home, ensure that all drugs in the home are kept beyond their reach. Iron overdose occurs when someone takes more than the normal or recommended amount of this mineral. Iron overdose is particularly dangerous for children. These children may not be able or willing to tell you what and how much they swallowed. If your symptoms or health problems do not get better or if they become worse, call your doctor. Tell your doctor if you are breast-feeding. Redlasso website can be described as an online information-entertainment platform with the core initiative to keep its followers informed and thoroughly entertained.Learn more, 2022 Redlasso - All Rights Reserved By Redlasso. A drug overdose may lead to serious issues such as death. is among the first to achieve this important distinction for online health information and services. Iron toxicity can be either sudden or gradual. follows rigorous standards of quality and accountability. It may occur when 1) people overdose on iron supplements, 2) take high-dose supplements for too long or 3) suffer from a chronic iron overload disorder. to make sure that it is safe for you to take this medicine (iron tablets and capsules) with all of your drugs and health problems. Filed Under: Nutritional Supplements, Resource Center. is also a founding member of Hi-Ethics. The amount of elemental iron in an iron supplement can be calculate based on the percentage it constitutes for per tablet. Your requirement for iron may also increase slightly if you've recently had surgery or lost blood; if you have a condition that causes malabsorption of nutrients or inflammation in the digestive tract, such as celiac disease or Crohn's disease; or if you have kidney failure. Never take iron supplements unless recommended by your doctor. Follow all instructions closely. Here are some do's and don'ts for avoiding an accidental overdose. If you or someone you are with has an overdose, call the local emergency number (such as 911), or the local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. Many manufacturers have changed their pills so they no longer look like candy. Advertising revenue supports our not-for-profit mission. include protected health information. And what the regular dosage says? Discuss with your patients the risks of accidentally overdosing on iron, as well as what they should do if they accidentally skip a dose. If the doctor suspects your child has also swallowed other medications, they may give your child activated charcoal to drink. This medicine prevents many other drugs from getting into the body. prothrombin and partial thromboplastin time, "Iron Ingestion: an Evidence-Based Consensus Guideline for Out-of-Hospital Management", "Iron Poisoning - Injuries and Poisoning", "Iron poisoning: a literature-based review of epidemiology, diagnosis, and management", "Initial Evaluation of Shock in Children", https://en.wikipedia.org/w/index.php?title=Iron_poisoning&oldid=1118570988, Short description is different from Wikidata, Creative Commons Attribution-ShareAlike License 3.0, Abdominal pain, diarrhea, vomiting, black stool, Vomiting, obstruction of small intestine preventing passage of food (due to scarring), Ferrous sulfate contains 20% elemental iron per mg of mineral salt, Ferrous gluconate contains 12% elemental iron per mg of mineral salt, Ferrous fumarate contains 33% elemental iron per mg of mineral salt, This page was last edited on 27 October 2022, at 19:13. Learn what causes iron deficiency and how. It is used to help growth and good health. Keep away from children. Severe iron overdose occurs with amounts of iron 50 to 100 times greater than the recommended dietary dose. Keep medications where children cannot get to them. Due to the disintegration of iron tablets, the stool may appear as black or dark green or gray. Stomach cramps. Iron and heavy metals. 24th ed. And sometimes iron can be low for reasons other than iron intake. Call your doctor or 911 if you think you may have a medical emergency. But I definitely wouldn't take that much without recommendation by a doctor. [3][1][4], The deferoxamine challenge test is a diagnostic test for confirming iron poisoning, however it is no longer recommended for diagnostic purposes due to concerns regarding the accuracy. However, it all depends on As a general guideline, patients who have ingested lower doses of elemental iron, have a peak serum iron level less than 500mcg/dL and are asymptomatic or only exhibit mild gastrointestinal symptoms typically do not require treatment and should be monitored for 6 hours after ingestion. Rosen's Emergency Medicine: Concepts and Clinical Practice. It is as a result of these strong opioids that the American President declares an epidemic in that regard back in 2017. In 2021 we had over 1.2 million pills, and this last year we had over 1.4 million pills come into my community." Maybe this is different for people with anemia? For the most part, this minimizes the harmful effects of excess iron. Ferrous sulfate systemic 325 mg (medicine). Observational studies suggest that a high intake of heme iron may increase the risk of colon cancer (18, 19). However, iron supplements provide higher amounts of dietary iron.1, Initial signs of iron overdose are usually nausea and abdominal pain but may also include diarrhea and vomiting blood.2 These initial symptoms will usually begin within six hours of the overdose and then appear to improve after 24 to 48 hours. Iron supplements are also sold by themselves. [4] Normal saline is administered intravenously to maintain adequate volume of fluid in the body. Poisoning. Amounts below 20 mg/kg are usually safe but may cause mild digestive symptoms. High iron stores -> Levels of hepcidin increase -> Iron absorption decreases. you should absolutely get help immediately. The person may have. All local poison control centers in the United States use this national number. pharmacist if you have questions about the best way to throw out drugs. Usually children require no more than 24 hours of therapy. Under normal circumstances, very little free iron circulates in the bloodstream. information highlighted below and resubmit the form. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. If you belong to the category of those who abuse drugs, it is ideal that you quit. Iron corrodes your intestinal lining and is a direct irritant to the stomach. The glycemic index (GI) is a value used to measure how much a specific food increases your blood sugar levels. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Manifestation of iron poisoning may vary depending on the amount of iron ingested by the individual and is further classified by five stages based on timing of signs and symptoms. Be sure to read the labels before taking any supplements to make certain that you are within the safety range of 45 milligrams of iron for adults. However, a few disorders that suppress hepcidin production can lead to iron overload. However, it is important to follow the directions carefully, since iron overdose in Immediately go to a hospital if you or someone you know may have. Likewise, those who donate blood frequently are at lower risk. The tolerable upper limit set by the Institute of Medicine recommends that you take no more than 45 milligrams of elemental iron a day. WebScore: 4.8/5 (25 votes) . because the border is not secure." Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. WebAccording to the Institute of Medicine, most adults can consume up to 45 milligrams of elemental iron daily without toxicity occurring. The Iron Disorders Institute indicates that even a mild case of iron toxicity may increase your risk for heart attack, diabetes and cirrhosis of the liver. Whether taking more than that over a long period of time is safe is unknown. Take iron exactly as directed. WebThe amount of iron you need is: 8.7mg a day for men over 18 14.8mg a day for women aged 19 to 50 8.7mg a day for women over 50 You should be able to get all the iron you need Accessed Oct. 2018. [7] Persistent vomiting is often associated with iron poisoning and also used to determine severity of iron poisoning. doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: All drugs may cause side effects. This article explains how coffee and caffeine affect iron. In this case, some of the strategies deployed by healthcare practitioners include: giving the patient activate charcoal which helps in the absorption of the drug. This article is for information only. This national hotline will let you talk to experts in poisoning. Iron overdose is particularly dangerous for children. Unfortunately, after this initial phase, more serious symptoms can occur, including:2, However, liver and cardiac failure are the biggest risks from an iron overdose.2,3, The first line of treatment is a procedure called whole bowel irrigation. As of 2017, there were over 70,000 Americans who died as a result of drug overdose issues. Iron overload and high-dose iron supplementation may increase the risk of infection in certain individuals. For example, a 300mg tablet of ferrous fumarate will contain 100mg of elemental iron or 33%.