Treatment of anemia of various etiologies suggests iron supplementation. Along with their great popularity there is a significant number of cases of intoxication by iron products. Great risk of poisoning by iron preparations are children. For year-old child dose of pure iron in 3 g - deadly. In adults with preroralnom receiving 10-20 mg / kgof pure iron is showing signs of lesions of the gastrointestinal tract, while taking more than 60 mg / kg of ironintoxication develops, doses greater than 100 mg / kg are life-threatening, more than 200 mg / kg - lead tolethal.
Symptoms of poisoning with iron differs depending on the stage of intoxication, but the rate of occurrence of certain symptoms in different patients may be different. Differentiation of symptoms involves the allocation ofseveral stages.
In the first stage (within the first 6 hours) observed symptoms associated with acute gastroenteritis: nausea, pallor, pain in the upper abdomen, diarrhea, vomiting brown masses, drowsiness, sweating, irritability, sudorgi.Along with local manifestations of intoxication develop water-electrolyte disturbances. For severe casescharacterized by impaired microcirculation, coagulopathy, the occurrence of acidosis, bloody vomiting, melena,cyanosis, coma, shock and development. With a high content of iron in the blood was rapid breathing and heart rate, increased blood acidity. A significant drop in blood pressure can lead to loss of consciousness, which, together with gastrointestinal disorders (stool and vomiting blood) is an indication of severe intoxication. The first symptoms may appear as early as 30 - 60 minutes. If at the initial stage there is no vomiting, the probability of severe poisoning is very small.
The second stage is marked as latent. It is characterized by the presence of a light period during which the first symptoms are smoothed. Asymptomatic period can last from 6 to 24 hours. However, the external improvement of health is accompanied by damage cells appears tachycardia, drowsiness, acidosis.
During the third shock, steps (12 - 48 hours), often relapse. There is a further development of acidosis,cyanosis, anuria, hyperthermia, pulmonary edema. Along with symptoms of systemic toxicity, there are signs of CNS (drowsiness, hyperventilation, epileptic syndrome, coma). Body experiences profound shock due tohypovolemia, vasodilatation and cardiac lesions, which often leads to death. In severe cases, hemodynamic instability observed in the first hours after the poisoning.
For the fourth stage (2-3 days after poisoning) characterized by the development of acute liver failure.
During the fifth step (from 2 to 8 weeks), cicatricial stenosis develops pylorus may progression of cirrhosis. CNS disorders occurring in the long term, irreversible.
First aid is aimed at the removal of iron from the stomach. If consciousness is impaired, induce vomiting usingsyrup of ipecac. You need to wash out the stomach with plenty of water. Can be used to wash a 1% solution of baking soda, which will reduce the absorption of iron. Activated charcoal in this case does not give the desired effect. You should always call an ambulance. When hospitalization is washed with stomach by gavage. For the treatment of poisoning by iron preparations used deferoxamine, antidote and symptomatic therapy.
Diagnosis of poisoning by iron preparations based on laboratory tests and X-rays of the abdomen and thorax.
The main laboratory studies include:
- Complete blood count;
- Determination of glucose and electrolytes in the blood;
- Determination of the concentration of iron (serum investigated);
- Determination of TIBC;
- Liver function tests.
When the diagnosis should be a differential diagnosis of a viral infection, alcohol poisoning, ketoacidosis,gastritis, etc.
