1 / 13

Iron poisoning

Iron poisoning. INTRODUCTION. Although iron poisoning is the most common cause of death due to poisoning in young children , it is also a significant problem in adolescents and adults. pharmacokinetic. Total body iron = 3-5gr Ferrous =70% , myoglobin and hemoglobin

linda-cochran
Download Presentation

Iron poisoning

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Iron poisoning

  2. INTRODUCTION Although iron poisoning is the most common causeof death due to poisoning in young children , it is also a significant problem in adolescents and adults.

  3. pharmacokinetic Total body iron = 3-5gr Ferrous =70% , myoglobin and hemoglobin ferric =25% , ferritin and hemosiderin Transferrin and enzymes =5% Absorption duodenom proximal jejunum

  4. Amount of elemental iron in tablets • Sufate 300/325mg 20% • Fumarate 200mg 33% • Gluconate 300mg 12% • Mulitivitamins : • Children’s chwable 4_18mg/tab • Adult 6_50mg/tab • Prenatal 36_65mg/tab

  5. Pathophysiology Iron is potent catalyst of free radical formation and is capable of oxidizing a wide range of substrates ,including lipid, protein,DNA, and various biomolecules. Typical iron poisoning targets: • GI • CVS • Liver • CNS • Hematopoietic system • Metabolic acidosis

  6. GI:abdominalpain,vomiting,bleeding,intestinal Infarcts • CVS:hypotension,low cardiac out put,cardiomyopathy,Hypovolemia,hypoperfusion • Liver:hepaticnecrosis,hypoglycemic,encephalopathy, Coagulopathy • Hematopoietic system :coagulopathy • CNS:lethargic,coma,seizure • Metabolic acidosis

  7. Clinical presentation • Stage1-GI (0.5-6h):abdominal pain,vomiting,darrhea, Hematemesis,hematochezia,melena • Stage 2-relative stability(4-12h):GI symptoms improve,subclinicalhypoperfusion • Stage 3-shock and acidosis(6-72h):hypoperfusion, metabolic acidosis,coma,coagulopathy,ARDS, potential multisystem failure • Stage 4-hepatic necrosis(12-96h):coma,coagulopathy, Jaundice • Stage 5-bowel obstruction(2-4w):abdominal pain,vomiting,dehydration

  8. Diagnosis • clinical • History • physical exam • laboratory: 1-abdominal radiograph,2-serum iron concentration,3-ABG,CBC,BS,BUN,Cr,Coagulation profiles,LFT,electrolytes,crossmatch • Differential diagnosis: consider metabolic, structural,infectious and other poisoning with GI symptoms

  9. Iron toxicity • No symptoms for 6h =No toxicity • <300 microgram/dl No toxicity • 300-500 mild • >500 severe • <20mg/kg only vomiting and nausea • >60mg/kg toxic

  10. Treatment • 1.stabilize patient as needed • 2.estimate risk for systemic toxicity by amount of elemental iron • 3.IV access • 4.laboratory exam • 5.GI decontamination:whole bowel irrigation if tablets are seen on radiograph(PEG 2lit/h in adult,1lit/h in children) • 6.chelation

  11. Chelation • Iron antidote= Deferoxamine (DFO) = a growth factor found in the streptomycespilosus • Mechanis :Fe binding, vinrose(challeng test) • Indications:serumfe>500, notable clinical symptoms(coma, hypovolemia,coagulopathy,metabolic acidosis),many tablets at radiograph,remain symptoms+300-500fe) • Dose: 15mg/kg/h infusion for no longer than 24h and max 30 mg/kg/h

  12. Criteria for stopping therapy: improving symptoms,Fe<150mic/dl,lack of tablets, normal urine color • Side effects: hypotension,rash,sepsis,ARDS(>24h)

  13. THE END

More Related