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Y3R2 - Toxicology ☠️ > L4: Iron > Flashcards

L4: Iron Flashcards

1
Q

Manner of Poisoning by Iron Toxicity

A
  • Iron toxicity typically occur in children, 3-5 tablets may induce significant toxicity according to amount of elemental iron contained in ingested preparation.
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2
Q

Toxic Action of Iron Toxicity

A
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2
Q

Distribution of Iron

A

Transferrin Carier

  • Iron is transported in the blood by transferrin.
  • When binding sites on transferrin are saturated, Unbound iron reacts with blood vessels and platelets.
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2
Q

Absorbtion of Iron

A
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2
Q

Elimination of Iron

A
  • There is no significant natural route of elimination other than by Gastrointestinal cell loss & blood loss.
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2
Q

1st GI Phase of Iron Toxicity

A
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2
Q

CP of Iron Toxicity

A

Severe iron poisoning may proceed in four phases

  • 1st Gastrointestinal phase (Gastrointestinal effects)
  • 2nd Window phase
  • 3rd Multi-organ failure phase
  • Late complications phase
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3
Q

2nd window Phase of Iron Toxicity

A
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3
Q

3rd Multi-Organ Failure phase of Iron Toxicity

A
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3
Q

Late Complications phase of Iron Toxicity

A
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3
Q

Investigations in Iron Toxicity

A
  • Blood Iron Level
  • Abdominal X-ray
  • Electrolytes, Arterial blood gases & Blood glucose level & Full blood count
  • Renal and Liver functions & Coagulation studies.
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4
Q

Blood Iron level investigations

A
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5
Q

What Might Abdominal X-Ray show in cases of Iron Toxicity?

A
  • To identify radio-opaque tablets
  • however their absence does not exclude iron overdose.
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6
Q

Determination of severity of Iron Toxicity

A
  • Clinical Evaluation.
  • Blood Iron Level.
  • Dose of Ingested Elemental Iron
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6
Q

Dose of Ingested elemental Iron

A
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6
Q

TTT aspects of Iron Toxicity

A
  • Emergency and supporlive
  • Decontamination
  • Antidote: (Desferrioxamine)
7
Q

Emergency & Supportive TTT of Iron Toxicity

A
  • Severe poisoning requires close monitoring (ABC, CVP line, regular electrolytes, blood gases and blood sugar monitoring)
  • Volume replacement may be required (blood, fresh frozen plasma or crystalloids)
  • Correction of acidosis.
7
Q

Decontamination options in Iron Toxicity

A
  • Activated Charcoal
  • Gastric Lavage
  • Whole bowel irrigation
7
Q

Is Activated Charcoal effective in Iron Toxicity?

A
  • Not effective.
  • Iron is not adsorbed to charcoal.
8
Q

Gastric Lavage in Iron Toxicity

A
  • Limited value
  • Intact tablets may not pass via lavage tube
8
Q

What is the Method of choice of decontamination in Iron Toxicity?

A

Whole bowel irrigation

9
Q

Indications for WBI

A
  • Ingestions >60 mg/kg confirmed on X-ray.
  • Un-dissolved tablets were detected on abdominal x-ray.
  • Sustained release or enteric coated iron tablets were reported.
10
Q

Antidote in Iron Toxicity

A

(Desferrioxamine)

11
Q

Dose & Route of Desferrioxamine

A
  • Desferrioxamine is given intravenously at a rate of 15 mg/kg body. weight/hour.
  • Reduce dose by 50% in severe renal impairment.
  • The urine will often (but not always) change to vin rose color.
11
Q

MOA of Desferrioxamine

A
  • It chelates ferric iron and causes redistribution of iron from tissue sites back into plasma.
  • The iron- desferrioxamine complex is renally eliminated.
12
Q

SE of Desferrioxamine

A
  • Desferrioxamine infusion for greater than 24 hours may result in Non-cardiogenic pulmonary edema.
12
Q

End point of therapy by Desferrioxamine

A
  • Treatment should be continued until serum iron concentrations fall below 60 micromol/ L
  • The urine (if it changed color) has returned to normal.
  • This normally takes 6-8 hours of treatment but may be longer in severe poisoning.
13
Q

Indications of Desferrioxamine

A
14
Q

When to Cease Desferrioxamine?

A

Y3R2 - Toxicology ☠️ (15 decks)

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