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overview
- Can produce peroxide and hence free radicals
- Free radicals can cause major intracellular damage
- About 10% absorbed
- 20-60 mg/Kg of elemental iron is mildly to moderate toxic.
- Toxic quantities achieved more readily in children
- Toxicity is greatest in gastrointestinal cells and liver
Iron Overdose – stages
- Stage 1- Gastrointestinal within 6 hours (vomiting, Diarrhea -bloody, Hypotension – High Mortality )
- Stage 2 — Latent from 12-24 hours (symptoms improves )
- Stage 3 – Metabolic/cardiovascular from 12-24 hours up (hypotension, Metabolic acidosis, hypoglycemia )
to 2 days - Stage 4 — Hepatic – days (abnormal LFT)
- Stage 5 — Delayed – weeks
Management
- Measure Level at 4 hours
- if tables are visible on x-ray , consider whole bowel irrigation
- Toxicity
- less than 3mg/L – Mild Toxicity
- 3-5mg /L Moderate Toxicity
- more than 5mg/L – Severe toxicity
- Treatment: desferrioxamine – Desferrioxamine 5 mg/kg/h IV
- If >3 mg/L and symptomatic treat with desferrioxamine
- if >5 mg/L treat regardless of symptoms
- intervenous fluids
- monitor glucose
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