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Iron toxicity antidote2/3/2024 Stage IV: Clinical recovery, resolution of shock and acidosis usually by days 3-4.Hepatotoxicity from iron delivery via portal blood flow.Free radical damage to mitochondria disrupt oxidative phosphorylation which leads to lactic acidosis.GI fluid losses, increase capillary permeability, decreased venous tone.Primarily hypovolemic shock and acidosis, myocardial dysfunction also contributes.Stage III: Systemic toxicity: shock and hypoperfusion.controversy between toxicologists whether this stage exists in significant poisonings.Stage II: Quiescent phase with resolution of GI symptoms and apparent clinical improvement.Stage I: GI toxicity: nausea, vomiting, diarrhea, GI bleeding from local corrosive effects of iron on the gastric and intestinal mucosa.Stage 4: Hepatotoxicity/ Hepatic necrosis Metabolic acidosis, lactic acidosis, dehydration GI irritation: nausea and vomiting, abdominal pain, diarrhea Significant iron toxicity can result in a severe lactic acidosis from hypoperfusion due to volume loss, vasodilation and negative inotropin effects.Absence of GI symptoms within 6hr of ingestion excludes significant iron ingestion (exception: enteric coated tablets).Coagulopathy - direct effect on vitamin K clotting factors. Destroys hepatic mitochondria, disrupts oxidative phosphorylation → worsening metabolic acidosis.Hepatotoxicity (cloudy swelling, periportal hepatic necrosis, elevated transaminases).Cell membrane injury from lipid peroxidation.Direct hepatic, CNS, and cardiac toxicity (decreased CO and myocardial contractility).Inhibiting the electron transport chain causes lactic acidosis.Can lead to formation of gastric strictures 2-8 weeks post-ingestion.Usually affects, the stomach, duodenum, colon rarely affected.Causing vomiting, diarrhea, abdominal pain, and GI bleeding.Occurs early, usually within several hours.Direct caustic injury to gastric mucosa.^Total amount of elemental iron ingested calculated by multiplying estimated number of tablets by the percentages of iron in the tablet preparation (see above) Toxicity determined by mg/kg of elemental iron ingested Severity Amount of elemental iron ingested determines the risk, not the amount of iron salt Įlemental Iron Percentages Iron Preparation.Biologically a component of hemoglobin, myoglobin, catalase, xanthine oxidase, etc.Iron is the 4th most abundant atomic element in the earth's crust.
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