IRON POISONING

• 4 yr has consumed  60 mg/kg of iron tablet  and has reached hospital in 2 hours.he has vomiting and abd painhis xray shows pellets. serm iron 360 .what is the plan of management?
• The minimum toxic dose and the lethal doses of iron are not firmly established. The following symptoms and toxicities have been reported at various doses:
• Patients who ingest less than 20 mg/kg of elemental iron are usually asymptomatic.
• Ingestions of 20 to 60 mg/kg may or may not produce symptoms of serious toxicity.
• A small number of patients who have taken 40 to 60 mg/kg of iron are symptomatic. In one retrospective review of 199 acute iron exposures, none of the patients who ingested between 40 and 60 mg/kg of iron developed serious toxicity [15].
• Ingestions of more than 60 mg/kg can be associated with serious toxicity [2,12,16,17].
• Death from iron toxicity has been reported from a wide range of doses (from 60 to 300 mg/kg).

CLINICAL MANIFESTATIONS — The manifestations of iron toxicity are typically described in five (often overlapping) phases [12,15-17]:

• Gastrointestinal (GI) phase: 30 minutes to 6 hours after ingestion
• Latent, or relative stability, phase: 6 to 24 hours after ingestion
• Shock and metabolic acidosis: 6 to 72 hours after ingestion
• Hepatotoxicity/hepatic necrosis: 12 to 96 hours after ingestion
• Bowel obstruction: 2 to 8 weeks after ingestion

ESSENTIAL LAB INV

• Serum iron concentration — The best estimate of the severity of the overdose can be determined by performing a SIC measurement within four to six hours of the ingestion. For slow-release iron, a SIC should be obtained at eight hours [17,18]. Because iron is rapidly cleared from the serum, concentrations obtained after eight hours may be deceivingly low.

Peak serum iron concentrations typically correlate with the following levels of toxicity:

• Less than 350 mcg/dL (63 micromol/L) – Minimal toxicity.
• Between 350 and 500 mcg/dL (63 and 90 micromol/L) – Mild to moderate GI symptoms (rarely develop serious complications) [3].
• Greater than 500 mcg/dL (90 micromol/L) – Serious systemic toxicity.
• Greater than 1000 mcg/dL (179 micromol/L) – Significant morbidity and mortality [12,16,17,32,35

OTHERS-abd xray,electrolytes,lft,rft

treatment

stomach wash

Deferoxamine — Deferoxamine (DFO), administered intravenously, is the antidote of choice for serious iron overdose. It is a chelating agent that, in acute iron intoxication, binds with ferric iron (Fe3+) in the blood to form water-soluble ferrioxamine that is then excreted by the kidneys. Ferrioxamine gives urine the classically described “vin rosé” color, which actually is orange to reddish brown. DFO must be administered early in the treatment of iron overdose because iron moves rapidly from the circulation into cells, where, in acute intoxication, it is not readily accessible for chelation. (See ‘Kinetics’ above.)

Although there are no randomized trials or case-control series in humans evaluating the efficacy of deferoxamine as an antidote for iron overdose, anecdotal reports and case series describe improved clinical outcomes when deferoxamine is administered intravenously [52,53]. Studies in dogs have reported dramatically improved survival following lethal iron overdose for animals who received deferoxamine [54,55].

Indications for deferoxamine include any of the following [9]:

●Severe symptoms (hypovolemia/shock, lethargy/coma, persistent vomiting or diarrhea)

●Anion gap metabolic acidosis

●Peak serum iron concentration greater than 500 mcg/dL (90 micromol/L)

●Significant number of pills on abdominal radiograph

• Dose and duration of treatment — Deferoxamine should be administered intravenously at a continuous rate of 15 mg/kg per hour IV, which may be increased to a maximum of 35 mg/kg per hour, based on the severity of clinical symptoms [9]. Because of the kinetics of iron absorption and the possibility of lung toxicity with prolonged administration of deferoxamine, we suggest administering larger doses of deferoxamine during the first 24 hours of treatment [56]. There are no established guidelines for determining the optimum dose of deferoxamine. Consultation with a medical toxicologist and/or regional poison control center is recommended. (See ‘Additional resources’ below.)
• Recommendations for duration of deferoxamine therapy have used resolution of clinical symptoms such as metabolic acidosis and shock as the endpoint for stopping therapy [9,37]. However, such nonspecific guidelines may result in prolonged treatment and increase the risk of lung toxicity from deferoxamine [57,58]. We suggest that the decision to stop deferoxamine therapy be made in consultation with a medical toxicologist and/or regional poison control center, taking into consideration the patient’s clinical status and, perhaps, serum iron concentration. (See ‘Additional resources’ below.) The typical duration of therapy is about 24 hours.

other symptomatic measures