Pediatric Iron Toxicity Medication

  • Author: Jennifer S Boyle, MD, PharmD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Apr 12, 2012
 

Chelation agents

Class Summary

Deferoxamine is a specific iron chelator. In the presence of ferric iron, deferoxamine forms the complex ferrioxamine, which is excreted by the kidneys. This complex imparts a reddish, vin rosé, color to the urine. Deferoxamine does not bind iron that is present in hemoglobin, hemosiderin, or ferritin. Deferoxamine is a parenteral iron chelator. It is administered IV or IM in the management of acute iron toxicity.

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Deferoxamine mesylate (Desferal)

 

Freely soluble in water. Approximately 8 mg of iron is bound by 100 mg of deferoxamine. Most effective when continuously provided to the circulation by infusion. May be administered either by IM injection or by slow IV infusion. Does not effectively chelate other trace metals of nutritional importance. Provided in vials containing 500 mg or 2 g of lyophilized sterile drug. Add 2 mL or 8 mL of sterile water for injection to each vial, bringing the concentration to 250 mg/mL. For IV use, this may be diluted in 0.9% sterile saline, 5% dextrose solution, or Ringer solution.

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Deferasirox (Exjade)

 

Tab for PO susp. PO iron chelation agent demonstrated to reduce liver iron concentration in adults and children who receive repeated RBC transfusions. Binds iron with high affinity in a 2:1 ratio. Approved to treat chronic iron overload due to multiple blood transfusions. Treatment initiation recommended upon evidence of chronic iron overload (ie, transfusion of about 100 mL/kg packed RBCs [about 20 U for 40-kg person] and serum ferritin level consistently >1000 µg/L).

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Whole bowel irrigation agents

Class Summary

Polyethylene glycol is used to increase GI transit time, decreasing absorption. It is not absorbed and is excreted entirely through the GI tract.

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Polyethylene glycol (GoLYTELY, NuLytely, Colovage, Colyte)

 

Laxative with strong electrolyte and osmotic effects that has cathartic actions in GI tract.

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Contributor Information and Disclosures
Author

Jennifer S Boyle, MD, PharmD  Consulting Staff, Emergency Medicine/Medical Toxicology, Salem Veterans Affairs Medical Center

Jennifer S Boyle, MD, PharmD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

David T Lawrence, DO  Assistant Professor, Department of Emergency Medicine, Division of Medical Toxicology, University of Virginia School of Medicine

David T Lawrence, DO is a member of the following medical societies: American College of Emergency Physicians and American College of Medical Toxicology

Disclosure: Nothing to disclose.

Christopher P Holstege, MD  Associate Professor of Emergency Medicine and Pediatrics, University of Virginia School of Medicine; Chief, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Center; Medical Toxicology Fellowship Director, University of Virginia

Christopher P Holstege, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, European Association of Poisons Centres and Clinical Toxicologists, Medical Society of Virginia, Society for Academic Emergency Medicine, Society of Toxicology, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Kathryn Clark Emery, MD  Associate Professor, Department of Pediatrics, University of Colorado Health Sciences Center; Consulting Staff, Department of Emergency Medicine, Children's Hospital of Denver

Kathryn Clark Emery, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Halim Hennes, MD, MS  Division Director, Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director of Emergency Services, Children's Medical Center

Halim Hennes, MD, MS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

  1. Chang TP, Rangan C. Iron poisoning: a literature-based review of epidemiology, diagnosis, and management. Pediatr Emerg Care. Oct 2011;27(10):978-85. [Medline].

  2. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline].

  3. [Best Evidence] Ziegler EE, Nelson SE, Jeter JM. Iron supplementation of breastfed infants from an early age. Am J Clin Nutr. Feb 2009;89(2):525-32. [Medline].

  4. Juurlink DN, Tenenbein M, Koren G, Redelmeier DA. Iron poisoning in young children: association with the birth of a sibling. CMAJ. Jun 10 2003;168(12):1539-42. [Medline].

  5. [Guideline] Manoguerra AS, Erdman AR, Booze LL, et al. Iron ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(6):553-70. [Medline].

  6. Bryant SM, Leikin JB. Iron. Critical Care Toxicology. 2005;687-693.

  7. Desferal (deferoxamine mesylate) [package insert]. East hanover, NJ: Novartis Pharmaceuticals Corporation; 2007. [Full Text].

  8. Eldridge DL, Holstege CP. Utilizing the laboratory in the poisoned patient. Clin Lab Med. Mar 2006;26(1):13-30, vii. [Medline].

  9. Engle JP, Polin KS, Stile IL. Acute iron intoxication: treatment controversies. Drug Intell Clin Pharm. Feb 1987;21(2):153-9. [Medline].

  10. Fine JS. Iron poisoning. Curr Probl Pediatr. Mar 2000;30(3):71-90. [Medline].

  11. Jacobs J, Greene H, Gendel BR. Acute iron intoxication. N Engl J Med. Nov 18 1965;273(21):1124-7. [Medline].

  12. Madiwale T, Liebelt E. Iron: not a benign therapeutic drug. Curr Opin Pediatr. Apr 2006;18(2):174-9. [Medline].

  13. McGuigan MA. Acute iron poisoning. Pediatr Ann. Jan 1996;25(1):33-8. [Medline].

  14. Perrone J. Iron. Goldfrank's Toxicologic Emergencies. 2006;629-637.

  15. Siff JE, Meldon SW, Tomassoni AJ. Usefulness of the total iron binding capacity in the evaluation and treatment of acute iron overdose. Ann Emerg Med. Jan 1999;33(1):73-6. [Medline].

  16. Tenenbein M. Position statement: whole bowel irrigation. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1997;35(7):753-62. [Medline].

  17. Tenenbein M. Whole bowel irrigation in iron poisoning. J Pediatr. Jul 1987;111(1):142-5. [Medline].

 
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The oxidative potential of iron was first proposed by Fenton in 1894. The importance of reduced oxygen species in biological reactions became apparent with the discovery of superoxide dismutase by McCord and Fridovich in 1969. The potential role of metal ion catalysis was reported the following year. Subsequently, a plethora of evidence has accumulated linking chronic excess body iron to cardiovascular disease, carcinogenesis, aging, stroke, Alzheimer disease, and Parkinson disease. The organ damage that occurs in the hereditary iron overloading disorders is well documented and can be averted and improved by decreasing the excess iron. Acute iron overload likewise produces tissue and organ damage due to the presence of free ionic iron.
 
 
 
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