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|Drug Toxicity with Specific Antidotes
⚠️ Iron toxicity is potentially lethal – check TOXBASE or national poisons advice immediately. Rapid recognition and treatment are essential, especially in children 👶, as toxicity can escalate quickly.
📖 About
- 💊 Iron supplements are common in households (for anaemia treatment), making accidental ingestion in children a frequent emergency.
- 👶 Children are at highest risk due to lower body mass and greater intestinal absorption capacity.
- 🩺 Toxicity can affect multiple systems – GI, cardiovascular, metabolic, hepatic – and follows a characteristic five-phase progression.
📊 Dose and Toxicity Thresholds
- 20–60 mg/kg: 🤢 Nausea, vomiting, diarrhoea, abdominal pain (GI upset).
- 60–120 mg/kg: ⚡ Systemic toxicity with metabolic acidosis, shock, and hepatic involvement.
- >120 mg/kg: ☠️ High risk of coma, cardiovascular collapse, death without urgent treatment.
🧠 Clinical Features
- 🎯 Phase 1 (0–6 h): Severe GI upset, haematemesis, melena, shock, metabolic acidosis.
- 😌 Phase 2 (6–24 h): Latent period – apparent improvement, but ongoing cellular injury.
- 💔 Phase 3 (24–48 h): Multi-organ toxicity – shock, metabolic acidosis, hepatic failure, coagulopathy, renal failure.
- ⏳ Phase 4 (2–6 weeks): Delayed strictures, GI scarring, risk of obstruction.
🔬 Investigations
- 🧪 Serum iron 4–6 h post-ingestion: >90 µmol/L = severe toxicity.
- 📉 ABG: metabolic acidosis (low bicarbonate, raised anion gap).
- 🩸 Bloods: U&E, LFTs, glucose, lactate, clotting.
- 📷 AXR: Radiopaque tablets visible in many cases – estimate load.
💊 Management
- 🛑 Initial stabilisation: ABCs, oxygen, IV access, fluid resuscitation.
- 🚫 Activated charcoal: Ineffective (iron does not bind).
- 🚽 Whole bowel irrigation: If large ingestion (>60 mg/kg) and tablets visible on AXR.
💉 Desferrioxamine Therapy
- Indicated for 💉 serum iron >90 µmol/L, shock, or severe toxicity.
- IM route: 1000 mg, then 500 mg q4h ×2; further doses 500 mg q4–12h (max 6 g/24h).
- IV route: 15 mg/kg/hr (max 80 mg/kg/24h) if shock/severe toxicity.
- 🧡 Chelation produces “vin rose” (pink–red) urine – a classic exam fact.
- Monitor renal output – adjust if oliguric/renal impairment.
⚠️ Complications
- GI bleeding and perforation.
- Fulminant hepatic failure within 48h (poor prognostic sign).
- Severe metabolic acidosis, electrolyte imbalance.
- Weeks later: GI strictures/obstruction.
📚 References
