Module 28.2 - Acute Iron Toxicity - Podcast скачать в хорошем качестве

Module 28.2 - Acute Iron Toxicity - Podcast

Welcome to the Creative Commons Rx Podcast! Before diving into this episode, I want to ensure we're all on the same page. This is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient or pharmacist-patient relationship is formed. Using this information and the materials linked to this podcast is at the user's risk. The content on this podcast is not intended to substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their health care professionals for any such conditions. Clinical experts created the references, content, and clinical insight. NotebookLM, a Google AI tool, created the audio content, which I extensively reviewed before release. Finally, the host states that he takes all conflicts of interest seriously. Currently, there are no conflicts to disclose. For all of his disclosures and the companies he invests in or advises, he directs users to reach out independently, where he keeps an up-to-date and active list of all disclosures. As clinicians engaged in medical education, we understand the critical nature of toxicologic emergencies. This module provides a comprehensive, essential overview of Acute Iron Toxicity, focusing on effective diagnosis and management. Clinical Stages and Systemic Effects Acute iron toxicity affects multiple organ systems, including the GI tract (risk of delayed stricture formation), liver (hemorrhagic hepatic periportal necrosis), and the cardiovascular system. Circulatory shock is identified as the most common cause of death, often stemming from hypovolemia, vasodilation, and a direct negative inotropic effect on the myocardium. We review the five classic clinical stages, highlighting the dynamic nature of presentation and the misleading "quiescent" phase (6–24 hours post-ingestion). Metabolic acidosis is a prominent and critical feature, resulting partly from the hydrolysis of unbound ferric iron liberating unbuffered protons. Diagnosis and Management Accurate diagnosis integrates clinical signs with laboratory markers. The serum iron concentration is the most effective parameter to gauge toxicity, with levels 500 per mu g per dL at 4–6 hours post-ingestion indicating pronounced systemic toxicity. However, note that Total Iron-Binding Capacity is of limited value. The presence of a high anion gap metabolic acidosis accompanied by an elevated lactate concentration is considered a reliable marker of serious cellular toxicity and necessitates chelation. Management begins with initial stabilization and prompt intravenous volume repletion. Given that activated charcoal is ineffective, Whole-Bowel Irrigation is the mainstay for GI decontamination if radiopaque tablets are visible. Deferoxamine (DFO) Chelation Therapy Deferoxamine is the parenteral chelator of choice, strongly indicated for moderate-to-severe systemic toxicity. DFO is a hexadentate chelator highly specific for ferric iron, binding it to form the renally excreted complex ferrioxamine. Critically, DFO should not be withheld in seriously poisoned pregnant patients. Endpoints for DFO therapy are primarily guided by clinical stability and the resolution of metabolic acidosis. Clinicians must be vigilant for associated risks, including Acute Respiratory Distress Syndrome linked to prolonged continuous infusions and the enhanced risk of sepsis from ferrophilic organisms like Yersinia enterocolitica.