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Ten minute toxicology: Iron

Ten minute toxicology: Iron. Russell Berger, MD Co-Director Medical Toxicology Cambridge Health Alliance. Need to establish right away how many mg/kg of ELEMENTAL IRON may have been ingested. Each formulation of iron has a different percentage of elemental iron: Ferrous Fumarate : 33%

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Ten minute toxicology: Iron

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  1. Ten minute toxicology:Iron Russell Berger, MD Co-Director Medical Toxicology Cambridge Health Alliance

  2. Need to establish right away how many mg/kg of ELEMENTAL IRON may have been ingested. • Each formulation of iron has a different percentage of elemental iron: • Ferrous Fumarate: 33% • Ferrous Sulfate: 20% • Ferrous Gluconate: 12%

  3. If you aint puking, you aint toxic. • Garth Algar: Uhm, Wayne? What do you do if every time you see this one incredible woman, you think you're gonna hurl? • Wayne Campbell: I say hurl. If you blow chunks and she comes back, she's yours. But if you spew and she bolts, then it was never meant to be.

  4. Example A 20 kg child ingests # 10, 300 mg ferrous sulfate tablets. Calculate the mg/kg of elemental iron the child ingested. 10 tablets x 300mg/tablet = 3000 mg total of which 20% is elemental iron = 600mg total elemental iron. Thus, 600mg/20kg = 30mg/kg ingestion.

  5. Iron toxicity • 20 mg/kg sick • 40mg/kg very sick • >60 mg/kg very, very sick…die

  6. Mechanism of toxicity • Direct corrosive effects on the GI tract • Iron causes cellular damage and acidosis (mechanism unknown). • Iron produces free radicals which are damaging to cell membranes.

  7. Stages of Toxicity • 1: Acute GI irritation. Hemorrhagic Gastritis/diarrhea • 2: Apparent improvement over the next 12 hours • 3:Coma, metabolic acidosis, liver failure, sepsis (yersinia) • 4:Scarring all along the GI tract resulting in strictures.

  8. Treatment • If symptomatic, check level • If patient is sick, the they should receive deferoxamine • Usual indications for deferoxamine are: • Shock • Profound acidosis • Level 500-600 or more

  9. Deferoxamine • Will make urine red tinged (vin rose) • Treatment beyond 24 hours may be associated with the development of ARDS • Rapid infusion can produce hypotension.

  10. Deferoxamine • Dosing: 10-15mg/kg/hr continuous infusion Treat until iron levels decreases to normal range

  11. Other modalities • Whole Bowel Irrigation • In Children, exchange transfusion may be indicated. • No role for dialysis. • No role for charcoal.

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