Was Bored so Took Too Much - Review

final_frontier_36_iron_maiden_wallpaper Nate-Tattoo

A 60 year-old aging death metal uber-fan walks into the ED crying, saying that he just tried to commit suicide. When you inquire further, he tells you that he is still sad about Iron Maiden breaking up. He hasn’t been the same since and honestly, he just hates Adele.

You ask him what exactly he did to try and end his life. He tells you that he had taken “a bunch” of his Iron pills while listening to The Number of The Beast on repeat.

What’s “a bunch”? About 10.

When? About 6.5 hours ago.

Any symptoms? Absolutely not, but he is anxiously awaiting for his medieval style death.

What is your prognosis and intervention for this patient?

This patient will not likely develop any toxicity since he has not had any GI symptoms within 6 hours. No intervention is necessary at this time.

Toxic doses of Iron:

<20 mg/kg (<300 mcg/dL): non-toxic or mild GI effects

20-60 mg/kg (300-500 mcg/dL): significant GI and possible systemic effects

>60 mg/kg (>500 mcg/dL): moderate to severe systemic toxicity

>1000 mcg/dL: severe systemic toxicity

You place him on 1:1 observation and call 212-POISONS since you know you got this wrong on the inservice.

Looking back at the cubicle you see the 1:1 is playing Angry Birds while the patient behind her is now scarfing down the rest of the bottle: about 20 pills.

What symptoms do you expect in the first stage?

The patient has ingested a toxic dose of Iron. The pills are most likely iron sulfate 325mg, which contain ~65 mg of elemental Iron. This means that the patient has taken approximately 30mg/kg which puts him in significant risk for severe GI symptoms (in particular, vomiting and diarrhea) and a moderate chance for systemic toxicity.

What are the systemic characteristics or stages of iron toxicity after the fist stage?

Stage 1: GI symptoms

Stage 2: Latent (does not happen in all patients)

Stage 3: Multiorgan failure – hepatic and renal failure, cardiomyopathy, coagulopathy (both due to direct effect on cascade and then later due to liver failure)

Stage 4: Hepatic stage – 2-5 days later

Stage 5: Delayed sequela – mostly long term GI complications due to corrosive damage.

Speaking of death metal, do you know the origin of the name Satan?

This word originates from Hebrew (שטן) and comes from the word for “astray”. Therefore, Satan leads people astray (along with other things) in the Torah, and later in Islam and Christianity.

References:

Tintinalli, Judith E., and J. Stephan. Stapczynski. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill, 2011. Print.