How much iron supplementation is enough for pediatrics?

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Good morning,

Oral Iron Supplementation is essential in the management of anemic patient.


Ferric Ammonium Citrate (FAC) 400mg/5ml mixture can be commonly found in government hospital setting in Malaysia, to be used as one of the iron supplementations for pediatric patients.


Dosing calculation for iron supplementation requires familiarization of iron content within each iron supplements.

One can be quite confused at first when they are new to FAC syrup dose calculation.


An important piece of information that should not be overlooked is that the strength of FAC syrup, 400mg/5ml, should NEVER be used in the calculation of amount of FAC required.

In fact, 400mg/5ml of FAC contains 86mg of *Elemental Iron* in every 5ml of the mixture. This is based on the approximation of molar mass ratio between iron and ferric ammonium citrate.

Molar mass :
Iron = 55.845 g/mol
Ferric Ammonium Citrate Citrate = 261.98g/mol
Approximation ratio calculation :
55.845/261.98 x 400 = 85.27 (approximately 86)



The dosing for iron supplementation is based on elemental iron requirement.
Iron elemental requirements are as follows:
Prophylaxis : 2mg/kg/day PO
Treatment : 6mg/kg/day PO
(As per Frank Shann Drug Doses 2019)

Dose Calculation Example:

 Body weight: 10kg

Daily elemental iron required : 
=10kg x 6mg/kg/day
= 60mg / day

Amount of FAC syrup required:
 =60mg/86mg x 5ml
=3.4883ml
Approximately 3.5ml

Another calculation method is that you may multiply the elemental iron required by 4.65:
= 60mg × 4.65 / 400 x 5ml
= 3.4875ml

*Note: 4.65 is the iron content ratio of FAC over elemental iron (400/86)


Reference:
1. Kementerian Kesihatan Malaysia. (2019). Paediatric Protocols for Malaysian Hospitals, 4rd Edition.

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