Iron Poisoning Pharmacology Case Study
\nHistory: A 13-year-old female who is 37 weeks pregnant presents to your
\nemergency department via EMS after ingesting 70 prenatal iron tablets
\ntwo hours ago in a suicide attempt. EMS reports arriving at the scene
\napproximately one hour after ingestion and administering ipecac. The
\ntablets contained 325 mg of ferrous sulfate. The patient complains of
\nthree episodes of emesis and diarrhea.
\nPMH: None.
\nPhysical Examination:
\nT: 98.6\u00b0F HR: 110 bpm RR: 12 breaths per minute BP: 100\/65 mm Hg
\nWeight: 65 kg
\nGeneral: Alert female in no distress
\nHEENT: Mucus membranes moist. Pupils equal.
\nPulmonary: Clear to auscultation.
\nCV: Tachycardic with regular rhythm and no murmurs.
\nAbdomen: Soft, mildly tender in epigastrium.
\nRectal: Heme negative.
\nNeurologic: Normal.<\/p>\n
Case Study questions
\n1. Did this patient take a toxic dose of iron?
\n2. Do you agree with the decision to administer ipecac? If not, is there a more
\ndesirable way to perform gastrointestinal decontamination in this case?
\n3. What laboratory studies, if any, do you recommend?
\n4. Do you recommend chelation in this patient? If yes, how would you administer the
\nchelator and at what dose? If the urine does not change color, should treatment
\nbe continued?
\n5. Is the fetus at high risk of becoming iron toxic?
\n6. What are the most common symptoms of iron poisoning?
\n7. Is iron detected on a routine toxic screen?
\n8. If an iron level is unavailable, are there any other laboratory findings that suggest
\nan elevated iron level (>300)?<\/p>\n
Toxicology Case Study: Iron Poisoning
\n1. Yes. For all poisonings of iron-containing vitamins, it is important to calculate
\n the amount of elemental iron ingested. Ferrous sulfate contains 20% elemental
\n iron, so this patient ingested 325 mg X 70 X 0.2 = 4550 mg. The total
\n amount\/kg is 4550\/65 = 70 mg\/kg. Because the toxic dose is 40 mg\/kg, this
\n patient has a potentially severe ingestion. Doses of 60-180 mg\/kg have been
\n associated with death.
\n2. Generally, there is no role for ipecac syrup administration. This is reflected by the
\nposition statement by the American Academy of Pediatrics on ipecac syrup. The
\nAmerican Academy of Medical Toxicology does not recommend emergency
\ndepartment administration of ipecac syrup but has no formal position on home
\nuse, though it is also not routinely recommended. Further, because the most
\nsensitive indicator of iron poisoning is vomiting, ipecac administration may confuse
\npotentially useful physical exam findings. If this patient had not already vomited or
\nif iron tablets were seen in the stomach on x-ray, gastric lavage would have been
\nthe initial decontamination procedure of choice. This technique can be employed
\nin patients who present early enough for this procedure to be initiated within one
\nhour of ingestion. If the patient remained symptomatic, if tablets were noted past
\nthe pylorus, or if the patient presented past the one hour mark, whole bowel
\nirrigation should be performed.
\n3. Laboratory studies that should be obtained include a serum iron concentration,
\nelectrolytes if the patient has had several episodes of vomiting and a complete
\nblood count if there is suspicion of any bleeding. The most valuable time to assess
\nserum iron concentration is four to six hours after ingestion. Total iron binding
\ncapacity (TIBC) is useless! While theoretically useful, the TIBC in iron poisoning is
\noften unreliable, falsely elevated, and does not correlate with symptoms.
\n This patient’s serum iron concentration is 400 mcg\/dL.
\n Na 137, K 3.4 C1 109, CO2 18, BUN 5, Cr 0.7 glucose 383
\n WBC 17.8 H\/H 13.1\/36.8 acetaminophen is <10, salicylate <5 mg\/dL.\n4. The most important indication for deferoxamine is symptoms of iron poisoning.\nMost patients become significantly symptomatic with levels over 300 mcg\/dL.\nPatients with severe symptoms (shock, lethargy\/coma), anion gap metabolic\nacidosis, peak SIC >500 mcg\/dL, significant numbers of pills on plain films and
\nworsening clinical condition despite maximal therapy should receive deferoxamine
\n(DFO), the intravenous chelating agent used to treat iron poisoning.
\nDeferoxamine can be administered IV or IM. This medication works by complexing
\nwith ferric (Fe3+) iron, creating the complex ferrioxamine, which is excreted in the
\nurine. Intravenous administration is generally safe if the rate is <5 mg\/kg\/hr;\nhowever in adults, if that rate is chosen, they will receive very large doses of\ndeferoxamine in 24 hours (25.2 grams). The recommended daily dose should not\nexceed 6-10 grams, so one can give 6 gm\/24 hours or 250 mg\/hr, which is\napproximately 3.5 mg\/kg\/hr. Another option is to start with 15 mg\/kg\/hr if the patient is very ill and decrease the dose after 1-2 hours. Larger doses are often\nused to start because prolonged dosing of DFO can cause adverse effects such\nas ARDS.\nFree iron may be present without the formation of the classic \u201cvin rose\u201d urine color\nchange. If the patient remains symptomatic with elevated iron levels, treatment\nshould continue even if there is no urine color change after the first dose of DFO.\n5. No, because the placenta has an active mechanism for iron to cross. It occurs by\nactive endocytosis. So if the mother has high iron levels, it is rare for the fetus to\ndevelop elevated iron levels. DFO probably does not cross the placenta, so\npregnant patients should be treated no differently than non-pregnant, except for\nuse of serial x-rays. Fetal monitoring should also be performed in pregnant\npatients with iron poisoning. If the fetus is viable and the mother is very ill or if\nfetal distress is noted, early delivery should be considered.\n6. Gastrointestinal (nausea, vomiting, diarrhea). Any child that presents with sudden\nonset of GI symptoms should be questioned about iron availability in the\nhousehold.\n7. No.\n8. Serum glucose >150, WBC >15,000 and acidosis all suggest a serum iron
\nconcentration greater than 300 mcg\/dL. If an iron level is available and there are
\nno other indications, those laboratories do not need to be routinely obtained.<\/p>\n","protected":false},"excerpt":{"rendered":"
Iron Poisoning Pharmacology Case Study History: A 13-year-old female who is 37 weeks pregnant presents to your emergency department via EMS after ingesting 70 prenatal iron tablets two hours ago in a suicide attempt. EMS reports arriving at the scene approximately one hour after ingestion and administering ipecac. The tablets contained 325 mg of ferrous […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1191,1192,1304,1303,1296],"tags":[1649,1651,1650,1637],"class_list":["post-5214","post","type-post","status-publish","format-standard","hentry","category-advanced-pharmacology-assignment-homework-help","category-case-study-answers-for-advanced-pharmacology","category-help-write-my-toxicology-case-study-assignment","category-homework-help-with-a-pharmacology-assignment","category-pharmacology-toxicology-case-study-assignment-help","tag-chelation-therapy","tag-healthcare-papers","tag-iron-poisoning","tag-toxicology-case-study"],"_links":{"self":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts\/5214","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/comments?post=5214"}],"version-history":[{"count":1,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts\/5214\/revisions"}],"predecessor-version":[{"id":5215,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts\/5214\/revisions\/5215"}],"wp:attachment":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/media?parent=5214"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/categories?post=5214"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/tags?post=5214"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}