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direct effects of iron
GI fluid loss
lactic acidosis / ischemia
metabolic acidosis
iatrogenic factors
coagulopathy
early acute phase
stage I
quiescent phase
stage II
recurrent phase
stage III
stage I GI symptoms
nausea/ vomiting/ diarrhea
abdominal pain
melena
hematemesis
stage IV GI
heaptic necrosis
stage V GI
gastric scarring
pyloric obstruction
nontoxic quantity
20 mg/kg
mild to moderate toxicity
20-40 mg/kg
moderate to severe
40-60 mg/kg
severe toxicity
>60 mg/kg
lethal toxicity
40-1600 mg/kg
gastrointestinal decontamination
cathartic
magnesium hydroxide
whole bowel irrigation
iron tests
serum iron
total iron-binding capacity
iron deficiency anemia
iron level low
TIBC high
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
normal serum iron range
0-100 micrograms / dl
potentially serous toxicity serum iron
350-500 micrograms/ dl
potentially fatal serum iron levels
>1,000 micrograms / dl
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
deferoxamine roa
IM
IV
deferoxamine IM
may be used if hypotension is not present
deferoxamine IV
use if hypotension or acidosis is present
deferoxamine treatment indications
patient is symptomatic
serum iron is greater than 500 micrograms / dl
serum iron level > total iron binding capacity
deferoxamine treatment duration
until vinrose color of urine is absent
until SI is <100 micrograms / dl
patient is asymptomatic
exchange transfusion
must be initiated early when the iron has not yet gone into tissues
hemodialysis necessity
if renal failure is present prior to or occurs after initiation of chelation therapy
hemodialysis will not
remove free iron but will remove iron bound to deferoxamine
hemodialysis supportive therapy
plasma expanders
vasoconstrictor agents
systemic alkalinization
pregnancy and hemodialysis
not a contraindication
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
toxicity of vitamin A overdose
may cause severe liver or brain damage
birth defects
adverse effect of vitamin D overdose
aortic stenosis - calcified aortic valve
amount for vitamin D overdose
> 100 ng/ml
vitamin e overdose
negative for liver markers of toxicity
< 720 mg/d
vitamin K overdose
decreases urinary calcium inc. hydroxyproline
may function in bone mass in postmenopausal osteoporosis