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| ==Background==
| | #REDIRECT [[Iron Toxicity]] |
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| - in blood fe bound to protein called transferrin. Reticuloendothelial sys removes xferrin from blood and stores fe as ferritin or hemosiderin
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| - ferum fe lvls- 50- 150 mcg/dl
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| - TIBC or xferrin lvl 300- 400 mcg/dl
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| - xferrin saturation 35% +/- 15%
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| - sys tox due to free Fe- free fe exists once total fe lvl exceeds fe binding capacity of xferrin
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| - fe normally lost thru bile, sweat, dermal and GI turnover
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| - causes vomitting, gi bleeds and deposits in liver- can cause coagulopathy and hypoglycemia later on
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| - can cause sz
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| - free fe and xferrin are vasodilators and neg inotrope
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| - can get met acidosis
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| - free fe goes intracellularly and uncouples mitochondrial electron xport from ox phosphorylation so get cellular asphyxiation.
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| also may increase lipid peroxidation and get free radicals to cause dysfnction of krebs cycle and e- xprt- theoretically free radical scavenger like vit E may be useful
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| ==Diagnosis==
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| PHASES
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| 1- corrosive effect on gut- abd pain, n/v/d,
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| 2- 2- 48 hr- apparent recovery and response to fluids
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| 3- 6- 48 hr- recurrence of gi sys, CV collapse, acidosis, leukocytosis, coagulopathy,
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| 4- 2- 5d, hepatic failure and hypoglycemia
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| 5- delayed sequelae of gi scarring
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| EVAL OF TOXICITY
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| - elemental fe determines toxicity, not amount of salt
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| liquid- 1- 20 mg fe/cc
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| chewable- 15 mg/tab
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| fe gluc- 12% elemental fe
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| fe sulf- 20%
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| fe fumrt- 33%
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| Elemental Fe Load=
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| (#tabs x (mg Fe salt/tab)x(%elemental Fe))/ pt wt
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| Predicted Tox
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| < 20mg/kg- nontox
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| 20- 60- mild to mod
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| > 60- severe
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| Labs
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| - get serum fe at 3- 5 hr and repeat @ 6- 8 hr
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| if less than 350mcg/dl min tox. > 500 mcg/dl- severe
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| - increased wbc. 15K and gluc >150 early on. If have this, then do defuroxime challenge test- if + admit
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| - kub with pills. 50mg/kg up to 1 gm im or 10 mg/kg iv and wait for 2 urinations for vin rose color change.
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| - met acidosis since neg inotrope and have lactic acidosis
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| ==Treatment==
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| - lavage
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| - whole bowel irrigation c golytly
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| - charcoal ineffective
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| - defuroxamine- chelates c fe to make ferrioxamine- water soluble and peed out. makes brown/ orange urine
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| 90 mg/kg im up to 1 gm in kids or 2 gms in adults- repeat q 4- 6hrs with daily max of 6 gms
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| if severe tox, 15 mg/kg/hr
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| - no compazine since can cause coma in combination c def
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| - can also dialyze the ferrioxamine
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| - if asymp for 6 hrs and neg labs, home
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| ==Source ==
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| 6/06 MISTRY
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| [[Category:Tox]] | |
