Iron

1
Iron
2
pharmacology

• total-body iron store averages about 4 grams in
  adults
• Transferrin carries iron into the cell
• Iron is stored in ferritin
• recommended daily intake of iron
• about 8 milligrams for boys, adult men, and
  nonmenstruating women
• 18 milligrams for menstruating women
• 27 milligrams for pregnant females

3
pathophys

• potent catalyst for the production of oxidants
  such as free radicals
• direct GI tract irritant and causes vomiting,
  diarrhea, abdominal pain, mucosal ulceration, and
  bleeding
• disrupts critical cellular processes and induces
  acidosis and widespread organ toxicity

4
toxicity

• Toxic effects are reported after oral doses as
  low as 10 or 20 milligrams/kg of elemental iron.
• moderate toxicity occurs at doses of 20 to 60
  milligrams/kg
• severe toxicity can be expected following
  ingestion of gt60 milligrams/kg
• a ferrous sulfate 325-milligram tablet contains
  65 milligrams of elemental iron
• approximately 20 to 35 tablets would be expected
  to produce moderate toxicity after an acute
  ingestion in an adult.

5
Clinical features

• Stage 1 of iron poisoning is characterized by
  abdominal pain, vomiting, and diarrhea
• Stage 2, or the "latent" stage, of iron poisoning
  does not always occur.
• Systemic toxicity characterizes stage 3 of iron
  toxicity
• Coagulapathy, renal failure, and cardiomyopathy

6
Clinical features

• Stage 4, the hepatic stage of iron poisoning,
  develops 2 to 5 days following ingestion
• Stage 5 of iron poisoning refers to delayed
  sequelae
• Example gastric outlet obstruction
• 4-6 weeks after ingestion

7
diagnosis

• In general, serum iron levels measured within 4
  to 6 hours after an acute ingestion correlate
  with the severity of toxicity
• low serum iron levels do not necessarily mean
  absence of toxicity
• Standard ferrous sulfate tablets are radiopaque
  and visible on routine radiographs

8
treatment
9
treatment

• Dont
• Syrup of epicac
• Activated charcoal
• Do
• Whole bowel irrigation
• Endoscopy
• deferoxamine

10
deferoxamine

• systemic toxicity, metabolic acidosis,
  progressive symptoms, or a serum iron level
  predictive of moderate to severe toxicity
• 1000 milligrams IV at a slow infusion rate

11
reference

• Tintinalli, Ch. 192