Iron poisoning by Abdelali Agouni https://padlet.com/aagouni78/31f8g2xkfdwn Made with big dreams en-us 2017-11-20 08:11:53 UTC 2019-10-27 08:50:01 UTC hello@padlet.com Iron 1 https://padlet.com/aagouni78/31f8g2xkfdwn/wish/402983351 1) I. Corrosive effects lead to perforation and GI fluid loss)
II. Excess protein binding causes cellular disfunction leading to lactic acidosis and necrosis 
(phantom reaction)

2) 
Less than 20 mg/kg: mostly asymptomatic 
20-30: self limiting vomiting, abdominal pain, and diarrehea 
above 40: Serious side effects
above 60: potentially lethal.

3) Phases of toxicity A-D
A: After ingestion, corrosive effects lead to vomiting, diarrehea, and bloody stool. 
B: pts experience a latent period of apparent improvement for 12 hours. 
C: An abrupt relaps with coma, shock, seizures, metabolic acidosis, coagulopathy, hepatic failure, and death. Yersinia enterocolitica sepsis may occur.
D: If the victim survives, scarring from the initial corrosive injury may result in pyloric stricture or other intestinal obstruction.

4) Clinical signs: Vomiting, diarrhea, hypotention
Lab tests: serum iron levels, Transferrin, Elevation of WBC, BG and visibal radiopaque pills on abdominal x-ray
Other lab tests: CBC, electrolytes, glucose, BUN, creatinine, LFTs, coagulation studies and x-ray.

5) ABC (Airway, Breathing, Circulation)
Treat Shock by IV crystalloid fluids and replace blood if needed. Treat coma, seizures and metabolic acidosis if present. 

6) deferoxamine 

7) Monitor for urine color for orange or pink-red color and serum iron

8) Prolonged therapy can cause respiratory distress syndrome and Yesinia sepsis. Rapid boluses usually cause hypotension (IM can also cause hypotension). 

9) Prehospital: cannot use charcoal. 
Hospital: if pt ingests liquid formulation or chewed tablet - Gastric lavage 
if pt ingested tabs and large numbers of the tabs are visible on plain abdominal x-ray - Whole bowel irrigation.

10) Charocaol does not adsorb iron. Ipecac can aggrevate iron-induced GI irritation. 

11) Exchange transfusion is occasionally used for massive pediatric ingestion but is of questionable efficacy. 
Hemodialysis and hemoperfusion are not effective at removing iron but may be necessary to remove deferoxamine-iron complex in patients with renal failure. ]]> 2019-10-27 08:20:16 UTC https://padlet.com/aagouni78/31f8g2xkfdwn/wish/402983351 Iron 3 https://padlet.com/aagouni78/31f8g2xkfdwn/wish/402983719 1) What are the mechanisms of iron toxicity?
Iron has a corrosive effect on mucosal tissue and leading to hemorrhagic necrosis and perforation which results in fluid loss from the GI tract and hypovolemia. 
Absorbed iron when there is an excess of protein binding causing cellular dysfunction which is proposed to be through iron ligands causing oxidative damage and free radical formation. Resulting in lactic acidosis and necrosis. 
2) List the symptoms of iron toxicity based on the following dose range.
• Less than 20 mg/kg: unlikely to display symptoms 
• 20-30 mg/kg: self limited vomiting, diarrhea and abdominal pain
• More than 40 mg/kg: potential serious
• More than 60 mg/kg: lethal dose 
3) Describe the four clinical phases of iron toxicity.
o Phase 1: The first phase involves symptoms of corrosion such as blood diarrhea and vomiting. Massive fluid loss or blood loss from the GI tract leads to shock, renal failure and death
 oPhase 2: Latent period of improvement which lasts for about 12 hours 
o Phase 3: Abrupt relapse characterized by metabolic acidosis, CNS symptoms such as coma, seizures, and shock. Yersinia entercolitica spesis can also occur. 
o Phase 4: If the patient survives from phase III they can get scarring from initial corrosion resulting in intestinal obstructions. 
4) Which laboratory tests and clinical signs are used to diagnose the
severity of iron poisoning in a patient?
clinical: vomiting and diarrhea which are often bloody, massive fluid and blood loss can cause shock, specific labs : serum iron more than 450-500 mg/dL, other labs: CBC, BUN, electrolytes glucose.
5) What would be first step of treatment in this patient?
Whole bowel irrigation because of the presence of tablets shown in the abdominal x-ray series.
6) What is the specific treatment or antidote for iron poisoning? How is
the antidote used clinically?
Administer deferoxamine. For seriously intoxicated victims (eg, shock, severe acidosis, and/or serum iron > 500–600 mcg/dL) 
7) How the clinical outcome of iron chelation therapy is monitored in a
poisoned patient?
Monitor the urine for the characteristic orange or pink-red (“vin rosé”) color of the chelated deferoxamine-iron complex or monitpr for serum iron level 
8) What are the complications of iron chelation therapy using
deferoxamine?
Prolonged deferoxamine therapy has been associated with adult respiratory distress syndrome and Yersinia sepsis.
9) Which methods of decontamination are useful in iron poisoning?
Gastric lavage, whole-bowel irrigation (extremely effective). DO NOT use activated charcoal or ipecac
10) Why the other methods of decontamination such as ipecac syrup and activated charcoal are not useful in iron poisoning?
Ipecac can aggravate iron-induced GI irritation and interfere with whole-bowel aggregation. Activated charcoal is not effective at adsorbing iron.
11) Is there any effective method to enhance elimination of iron in a poisoned patient?
No; hemodialysis and hemoperfusion may only be of benefit in CKD patients as they can remove the deferoxamine-iron complex

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