Flashcards in Pharm chelation therapy Deck (46)
normal role of iron
various intracellular processes (accepts and donates electrons), extracellular is bound to transferrin
when does iron toxicity occur?
free iron in circulation
what are the pharmacokinetics of iron?
peak serum concentrations occur 2-6 hours after ingestion (overwhelmed transferrin and increase in circulating free iron)
local toxicity of iron
direct corrosive effect to GI mucosa (leading to hematemesis, melena, periportal necrosis of liver and intetional ulceration and edema)
-resultant volume depletion
systemic toxicity of iron
-high anion gap metabolic acidosis
-uncoupler of oxidative phosphorylation!
-direct negative inotropic effect
early clinical effects of iron toxicity
local tissue effects of GI tract (nausea and lots of vomiting) within 6 hours
intermediate clinical effects of iron toxicity
nausea and vomiting may temporarily decrease with an increase in development of metabolic acidosis and sequelae
late signs of iron toxicity
severe local and system effects - hepatotoxicity, ARDS, renal, gastric outlet obstruction
chelator for iron poisoning
chelates FREE iron and iron transported between transferrin and ferritin
deferoxamine side effects
rate-related hypotension, anaphylactoid reactions, yersinia enterocolitis (facilitates growth of unusual organisms), acute lung injury/ARDS
-can only treat for 24 hours before acute lung injury manifests
clinical pearls for lead poisoning in kids
colic, lower levels associated with IQ changes, think PICA
clinical pearls for lead poisoning in adults
hypertension, tolerate higher lead levels
clinical pearls for arsenic poisoning
rice-water diarrhea, prolonged QT, arsenical dermatitis, "rain drops on a dusty road"
clinical pearls for mercury poisoning
labile mood "mad as a hatter", intention tremor, mercury salts: caustic