Question

From the following case, solve the questions:
5-year-old boy, previously healthy, taken to the emergency department by his parents, who report intake of 30 tablets of ferrous sulfate, one hour prior to the consultation. The milligrams ingested by the infant are unknown. It enters a regular general state, with poor peripheral and depressed perfusion; It presents the following picture: generalized mucocutaneous paleness, tachycardic and tachypneic. Presents epigastralgia and soft abdomen. He is admitted to the emergency department, receives supplemental oxygen, expansion with physiological solution followed by parenteral hydration and intravenous ranitidine.

1. Explain the entire process of Decontamination of patients with ferrous sulfate poisoning.

2 What type of medications should be administered as antidotes in this ferrous sulfate poisoning and for which the antidotes are used?

3. In the development of the case, the importance of the pharmacy regent in a pharmaceutical service in the whole process of patient care has been glimpsed from the moment he enters the emergency department until he is released. Which medications should the Pharmaceutical service have to take care of intoxicated patients? Explain.

4 Does the Patient Evaluation Control show a worsening of gastrointestinal function levels, and liver enzyme alterations? What relationship does this alteration have with ferrous sulfate, which should be done in this case? Check and explain the answer.

5. Make a step-by-step diagram of what should be done with a patient intoxicated with ferrous sulfate from the time they enter the emergency department, interdependent activities, until they leave.

Answer 1

1. This is a case of iron toxicity. The usual route of treatment is Whole Bowel Irrigation and Chelation therapy.

Decontamination: Vomiting may be induced by using an emetic drug. Decontamination is started with gastric lavage or whole bowel irrigation with normal saline or polyethylene glycol-electrolyte solution.

This is followed by 1% sodium bicarbonate/ Magnesium hydroxide solution to precipitate residual iron as insoluble ferrous carbonate/ hydroxidde.

Egg yolk/ milk may be given orally to complex iron.

2. Antidotes:

To bind and remove already absorbed iron.

• Desferrioxamine (10-15 mg/Kg/h) as a continuous infusion to a maximum of 6 g.
• Alternatively, DTPA or calcium edetate may be used.