Remember our patient from a few weeks ago? He was the aging death metal fan who took one too many iron pills due to his profound sadness over the premature break-up of Iron-Maiden. (If not, give it a read to refresh your knowledge of Iron poisoning).
Nevertheless, Mr. Toomuchwhitebeard who ingested over 30mg/kg of elemental iron is now vomiting. He vomited once and you gave him ondansatron. He vomited twice and you gave him IV fluids and some metoclopramide. He vomited thrice and you called your local Toxicology Hero (featured on the Right) right before you ventured into a series of google and youtube searches for your treatment plan.
Concerned about Iron overdose that occurred <60minutes ago, what is your decontamination approach?The answer on the boards is: Whole bowel irrigation with polyethylene glycol. Lavage within 60 minutes may be useful, though the size of the pills and duration since ingestion may render it useless.
What is your treatment strategy for iron overload?
~see algorithm below.
- ABCs… fools, you obviously just thought about chelation, right?
- Supportive care: You will treat coagulopathies with FFP and vitamin K, shock with fluids, etc. and give plenty of antiemetics to prevent continuous GI irritation.
- Chelation therapy: Deferoxamine.
- Safe for children and pregnant women.
- Binds small amount of iron, but that’s enough to reduce systemic toxicity…
- You will treat either significant ingestion, systemic symptoms or iron levels (at 4 hours) of >500 mcg/dL.
- Give through separate IV. Give slowly. Give 1g at first (~6g over 24 hours).
- Complications are weird – look them up (like mucormycosis).
- End goal: controversial. The recommendation is to stop when clinically improved. Iron levels are unreliable during chelation therapy. Urine color change is also a measure that can be used (deferoxamine-iron complex makes urine rust colored). Get initial baseline urine.
- Exchange transfusion is last resort. Hemodyalisis is not effective to remove iron, but may be used to remove iron-deferoxamine complex if patient is in renal failure.
What part of their upper extremities do bats flap when they fly?Apparently they flap their digits and not their arms… Go figure. Thank you to Logan Jardin for this nugget
References: Tintinalli’s
Special thanks to Dr. Willis.
Written by Itamar Goldstein
The following two tabs change content below.
Resident in the combined Emergency and Internal Medicine program at Kings County Hospital and SUNY Downstate Medical Centers.
Like this:
Like Loading...
Related
0 Comments