Iron Toxicity in Emergency Medicine Medication
- Author: Clifford S Spanierman, MD; Chief Editor: Asim Tarabar, MD more...
Medication Summary
The goals of pharmacotherapy are to reduce iron levels, prevent complications, and reduce morbidity.
The chelating agent deferasirox is FDA approved for treating chronic iron overload. One study examined the usefulness of this agent in the management of acute iron ingestion. Among 8 healthy, human volunteers, those who received orally administered deferasirox 1 hour after iron ingestion experienced significantly reduced serum iron levels. This finding suggests deferasirox may be an effective treatment for acute iron toxicity.[2]
Chelating agents
Class Summary
Chelation is the mainstay of therapy. It is indicated for serum iron levels >350 mcg/dL with evidence of toxicity or >500 mcg/dL regardless of signs or symptoms.
Deferoxamine (Desferal)
DOC for iron intoxication. Freely soluble in water. Approximately 8 mg of iron is bound by 100 mg of deferoxamine. Excreted in urine and bile and gives urine a red discoloration. Readily chelates iron from ferritin and hemosiderin but not transferrin. Most effective when administered continuously by infusion. May be administered by IM injection or slow IV infusion. Does not effectively chelate other trace metals of nutritional importance. Provided in vials containing 500 mg of lyophilized sterile drug. Add 2 mL of sterile water to each vial for injection, bringing the concentration to 250 mg/mL. For IV use, may be diluted in 0.9% sterile saline, 5% dextrose solution, or Ringer solution. IM is preferred route of administration, except in hypotension and cardiovascular collapse when the IV route should be considered.
GI decontaminants
Class Summary
Because adsorption to activated charcoal is minimal, whole bowel irrigation is the GI decontamination method of choice.
Polyethylene glycol bowel prep (GoLYTELY, Colyte)
Laxative with strong electrolytic and osmotic effects that has cathartic actions in the GI tract.
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