8.15 C) Toxicology Iron

Front 1

In regards to Iron Ingestion, which of the

following is incorrect?
A. It remains a significant cause of paediatric morbidity and mortality
B. Ingestion of more than 60mg / kg of ELEMENTAL iron is associated with severe morbidity.
C. Ferrous carbonate has the highest % of elemental iron
D. Stage IV of iron toxicity is the phase of overt shock.

Back 1

D. Stage III = overt shock

+ metabolic acidosis

+ end-organ dysfunction.

Front 2

In regards to elimination, which of the following is correct regarding Iron ingestion > 60 mg/kg ?
A. Charcoal is indicated
B. > 60mg/kg + AXR confirmation = whole bowel irrigation (WBI)
C. Endoscopic removal is not indicated.
D. MDAC can be considered.

Back 2

B.

C : Surgical / Endoscopic removal can be

considered when Whole Bowel Irrigation fails, or is impractical ( Paediatric)

Front 3

Which is incorrect regarding iron ingestion?
A. Risk assessment is based primarily on serum levels.
B. Levels obtained > 6 hours post ingestion are unreliable
C. Vomiting is an indication of iron toxicity
D. A fall in serum bicarbonate is a good surrogate indicator of iron

toxicity.

Back 3

A = Iron Risk Assessment =

ingested dose

+ evolving clinical features

+ AXR

+ serum iron level at 4-6 hours

Front 4

Which of the following has the highest

percentage elemental iron ?

A. Ferrous Chloride
B. Ferrous gluconate
C. ferrous fumurate
D. Ferrous carbonate.

Back 4

D. 48%

Ferrous Carbonate = 48%

Ferrous Fumurate 33%

Ferrous Chloride 28%

Ferrous sulfate 20%

Front 5

List the descending order for % elemental iron in the following: (highest to lowest)
Ferrous lactate
Ferrous fumurate
Ferrous Chloride
Ferrous gluconate
Ferrous sulfate
ferrous carbonate

Back 5

Carbonate
Fumurate
Chloride
Sulfate
Lactate
Gluconate

Front 6

Can a normal AXR be used to exclude a

potential iron toxicity?

Back 6

No.

Liquid and Chewable Paediatric formulations are not typically radioopaque.

Front 7

The Antidote for iron toxicity is ?

Back 7

Desferrioxamine

Front 8

What are the indications for Desferrioxamine?

Back 8

1. Systemic Toxicity
- Shock
- Metabolic acidosis
- Altered mental status
2. Serum level elevation

- > 90 umol/L [ 4/24 post ingestion ]

Front 9

List the 3 main interventions for iron

ingestion ?

Back 9

1. Whole Bowel irrigation (WBI)
2. Surgical / Endoscopic removal
3. Desferrioxamine

Front 10

List the Stages of Iron toxicity. (Murray)

Back 10

Stage I **: Abdominal pain + vomiting /

diarrhoea + GI bleeding
Stage II ** : Quiescent phase
Stage III : Shock + metabolic acidosis (HAGMA)

+ end-organ dysfunction (Hepatorenal)
Stage IV : Acute hepatic failure +

coagulopathy + coma
Stage V : Cirrhotic live disease - GI fibrosis

Front 11

Detail the timing for each Stage of iron

toxicity?

Back 11

I = 0-6 hours **
II = 6-12 hours **
III = 12-48 hrs
IV = 2-5 days
V = 2-6 weeks

Front 12

Which is incorrect regarding the organ effects and pathophysiology of iron toxicity?
A. It has a direct corrosive effect on the GI mucosa.
B. It has direct myocardial toxicity .
C. Conversion of ferric to ferrous iron leads to disruption of oxidative phosphorylation.
D. Hepatic injury is caused by reactive oxygen species.

Back 12

C. Ferrous to ferric ---> hydrogen ions and

disruption of oxidative phosphorylation.

Front 13

Which is incorrect regarding Iron toxicity?
A. Seizures can occur.
B. Desferrioxamine is associated with Yersinia enterocolitica sepsis.
C. Absence of Symptoms after 4 hours since ingestion rules out

significant toxicity.
D. Desferrioxamine is an iron chelator.

Back 13

C. Absence of symptoms After 6 hours.