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Ipecac
3%
1/31
CaEDTA
Hemodialysis
N-acetylcysteine
0%
0/31
Deferoxamine
87%
27/31
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This patient is suffering from iron poisoning after ingesting his mother's nutritional supplements. Iron poisoning should be treated with deferoxamine, which acts by binding ferric iron and increasing urinary excretion. Iron poisoning often affects children who confuse iron supplements for candy. There are 4 phases of iron toxicity. Phase 1 occurs between the first half hour to 12 hours following ingestion and is characterized by abdominal pain, nausea, vomiting, and other symptoms of GI toxicity. Phase two is a latent phase that precedes phase 3. Phase 3 is characterized by systemic toxicity occurring 12 to 48 hours after ingestion and presents with metabolic acidosis, liver damage, cardiovascular toxicity, and CNS damage. Phase 4 occurs weeks after ingestion and is defined by late complications, including stenosis of the GI tract, cirrhosis, and lasting CNS damage. McGreggor et al. describe the process of managing common childhood poisonings, with special focus on triaging of patients and prioritization on airway, breathing, and circulation assessment and management. They recommend against gastric decontamination by either gastric lavage or activated charcoal, or the use of emetics. They recommend that if a specific toxidrome is suspected, then tests and treatment should be specifically tailored to the ingested agent. Aaseth et al. discuss different chelators used in the treatment of metal poisoning. EDTA and BAL (2,3-dimercaptopropanol) are no longer commonly employed in the treatment of metal intoxication due to unfavorable side-effect profiles and inconvenience of administration. They discuss three agents, deferoxamine, deferiprone, and desferasirox, that have been developed to combat iron toxicity. While deferoxamine must be administered intravenously or subcutaneously, deferiprone and desferasirox can be administered orally. Figure A displays a radiograph showing ingested radiopaque iron pills in a pediatric patient. Incorrect Answers: Answer A: Ipecac is a pro-emetic and should not be used in the treatment of iron poisoning. Answer B: CaEDTA can be used to treat lead poisoning. Answer C: Hemodialysis can be used as a second line treatment in iron poisoning if there is no improvement following deferoxamine administration. Answer D: N-acetylcysteine can be used to treat acetaminophen overdose
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