Management of Iron Toxicity

The treatment of Fe overdose starts with attention to supportive care and adequate fluid resuscitation.

  1. Isotonic fluids: Numerous reasons account for hypovolemia and poor perfusion. Start fluid resuscitation with isotonic fluid boluses to restore hypovolemia.
  2. Activated charcoal (or other oral complexing agents): This is INEFFECTIVE at binding Fe to limit absorption.
  3. Whole bowel irrigation: This may be considered when Fe tablets are visualized on the KUB film. However, no controlled studies support the efficacy of WBI and so individual risks and benefits should be considered. WBI is achieved by administration of polyethylene glycol (PEG) solution via NG tube at recommended rates of 500 mL/hr in children and 1.5 – 2 L/hr in adolescents and adults.
  4. Gastric lavage: Generally NOT recommended

Shock, syncope, sweating… and severe chest pain!

A 67-year old male is brought to hospital following an episode of syncope at home. He had just finished eating lunch at home when he developed severe crushing retrosternal chest pain radiating to his left arm, profuse sweating and vomiting. Shortly after the onset of the pain he lost consciousness and awoke to find himself on the floor. En route, he has several brief episode of dizziness and an impalpable radial pulse.