THÔNG TIN TÀI LIỆU
Patients with only mild vomiting and diarrhea in the early postingestion period still need urgent treatment but usually well WBI is the preferred method of GI decontamination Draw blood, as above, and begin parenteral deferoxamine therapy If available, send blood for serum iron levels obtain an abdominal radiograph, monitor the patient for hours An iron level of less than 350 mcg/dL taken to hours after ingestion in an asymptomatic patient with a normal radiograph suggests that the patient is at minimal risk and may be discharged Admission and continued chelation with deferoxamine are indicated for iron levels higher than 500 mcg/dL, the development of any symptoms, or a positive radiograph When serum iron levels are not available on an emergency basis, clinical decisions must be made based on symptoms, electrolytes, and abdominal radiography Observe the patient for hours Those who have normal screening tests and remain asymptomatic may be discharged Patients with abnormal screening laboratory tests should have an iron level sent for later reference Acidotic or symptomatic patients should be admitted and treated with deferoxamine All children alleged to have ingested iron are potentially at significant risk for life-threatening illness However, severe iron poisoning is uncommon compared with the number of children who develop only mild symptoms or remain entirely asymptomatic Thus, the emergency physician needs an approach that encompasses the response to the severely poisoned child and to most who will remain well As noted earlier, the amount of iron ingested is often hard to quantify, and minimal safe amounts are not well established Serum iron levels not correlate well with the likelihood of developing symptoms (usually a reflection of the serum iron that exceeds the iron-binding capacity and results in free-circulating iron) However, when drawn to hours after ingestion, iron levels lower than 350 mcg/dL generally predict an asymptomatic course Patients with levels in the 350 to 500 mcg/dL range often show mild phase I symptoms but rarely develop serious complications Levels higher than 500 mcg/dL suggest significant risk for phase III manifestations However, the serum iron determination is not always available on a stat basis Although serum iron levels are useful, toxicity from iron overdose remains a clinical diagnosis Ill patients require vigorous hydration and support Children who are completely asymptomatic hours after ingestion are unlikely to develop systemic illness Among laboratory studies, the presence of metabolic acidosis probably best correlates with toxicity Radiopaque material on abdominal
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