iron and vitamin poisoning (updated)

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36 Terms

1
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direct effects of iron

  • GI fluid loss

  • lactic acidosis / ischemia

  • metabolic acidosis

  • iatrogenic factors

  • coagulopathy

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early acute phase

stage I

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quiescent phase

stage II

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recurrent phase

stage III

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stage I GI symptoms

  • nausea/ vomiting/ diarrhea

  • abdominal pain

  • melena

  • hematemesis

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stage IV GI

heaptic necrosis

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stage V GI

  • gastric scarring

  • pyloric obstruction

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nontoxic quantity

20 mg/kg

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mild to moderate toxicity

20-40 mg/kg

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moderate to severe

40-60 mg/kg

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severe toxicity

>60 mg/kg

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lethal toxicity

40-1600 mg/kg

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gastrointestinal decontamination

  • cathartic

  • magnesium hydroxide

  • whole bowel irrigation

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iron tests

  • serum iron

  • total iron-binding capacity

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iron deficiency anemia

  • iron level low

  • TIBC high

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initiation of workup of iron poisoning

  • cbc

  • bun/creatinine/lytes/glucose

  • lft/pt/ptt

  • abg’s

  • kub

    • kidneys, ureters, bladder

  • tibc

  • serum iron levels

    • 4hrs after ingestion

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normal serum iron range

0-100 micrograms / dl

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potentially serous toxicity serum iron

350-500 micrograms/ dl

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potentially fatal serum iron levels

>1,000 micrograms / dl

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deferoxamine pharamacology

  • binds free iron

  • ferrioxamine is formed which is a stable chelate which prevents iron from entering into further reactions in vivo

  • minimally affects transferrin iron and does not affect cytochrome or hemoglobin iron

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deferoxamine roa

  • IM

  • IV

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deferoxamine IM

may be used if hypotension is not present

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deferoxamine IV

use if hypotension or acidosis is present

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deferoxamine treatment indications

  • patient is symptomatic

  • serum iron is greater than 500 micrograms / dl

  • serum iron level > total iron binding capacity

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deferoxamine treatment duration

  • until vinrose color of urine is absent

  • until SI is <100 micrograms / dl

  • patient is asymptomatic

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exchange transfusion

must be initiated early when the iron has not yet gone into tissues

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hemodialysis necessity

if renal failure is present prior to or occurs after initiation of chelation therapy

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hemodialysis will not

remove free iron but will remove iron bound to deferoxamine

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hemodialysis supportive therapy

  • plasma expanders

  • vasoconstrictor agents

  • systemic alkalinization

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pregnancy and hemodialysis

not a contraindication

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pitfalls in treating iron poisoning

  • Waiting until results of serum iron levels are returned before administering deferoxamine to moderately or severely symptomatic patients

  • Withholding deferoxamine from severely symptomatic patients only because serum iron levels are below TIBC

  • Sending a stage-II iron poisoning victim home

  • Relying only on a negative KUB, normal WBC and/or a normal serum glucose level to rule out significant iron ingestion

  • Using radioimminoassays when measuring serum iron

  • Not recognizing that deferoxamine causes a falsely low determination of serum iron levels by most laboratory methods

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toxicity of vitamin A overdose

  • may cause severe liver or brain damage

  • birth defects

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adverse effect of vitamin D overdose

aortic stenosis - calcified aortic valve

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amount for vitamin D overdose

> 100 ng/ml

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vitamin e overdose

  • negative for liver markers of toxicity

    • < 720 mg/d

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vitamin K overdose

  • decreases urinary calcium inc. hydroxyproline

  • may function in bone mass in postmenopausal osteoporosis