S15C192 - Iron

Question 1

Iron: pathophys

Answer 1

• Sx: n/v/d, abdo pain, mucosal ulceration, bleeding
• lactic acidosis
• toxicity occurs at doses 20-60mg/kg of elemental iron
• severe toxicity at >60mg/kg
• levels measured w/in 4-6h after ingestion correlate with toxicity but if low be cautious of preparation of iron

Question 2

Stages of Iron Toxicity

Answer 2

1. abdo pain, n/v/d w/in first few hours of ingestion
   - absence of GI Sx w/in 6h of ingestion excludes dx of significant iron ingestion
2. latent stage, 6-24h long, symptoms resolve (doesn’t always occur)
3. systemic toxicity, shock and lactic acdosis, coagulopathy
4. hepatic stage, develops 2-5d after ingestion, elevated transaminases, hepatic failure
5. delayed sequelae: eg. gastric outlet obstruction, occurs 4-6w after ingestion

Question 3

Iron OD: Tx

Answer 3

-clinical dx
-ABC
-D: NO charcoal, consider gastric lavage, endoscopy, WBI
-E: HD not effective
-F: deferoxamine if:
systemic toxicity, metabolic acidosis, progressive symptoms, iron level moderate/severe toxicity