4 The radiopacity of Fe varies with the preparation, time since ingestion, and amount of ingestion. Total iron binding capacity (TIBC), glucose, and WBC counts are unreliable in predicting iron toxicity. 1 Additional lab tests to consider obtaining include: After 6 hours, Fe distributes out of the intravascular compartment, and levels are less useful for predicting toxicity. 2 Laboratory Testingįor most preparations, a peak Fe level occurs 2–6 hours post-ingestion. The peak level predicts severity of iron toxicity and guides management decisions (see table below). If no vomiting has occurred within 6 hours after ingestion, then the patient likely did not ingest a toxic dose. This patient can be medically cleared. The lack of vomiting early after an ingestion (during stage I) has important clinical significance. Sequelae: Gastric outlet obstruction, small bowel obstruction Shock, acidosis, coagulopathy, coma, multisystem organ failure Latent toxicity: Resolution of local toxicity with ongoing cellular toxicity, hypovolemia, poor tissue perfusion (metabolic acidosis, ↑ lactate levels) Local toxicity: Nausea, vomiting, diarrhea abdominal pain, gastrointestinal bleeding
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