Iron Overdose

Last Updated on by frcemuser

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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