2025 – PAGE 211 – EMERGENCY MEDICINE & TOXICOLOGY
IBUPROFEN OVERDOSE
Ibuprofen may act similarly to ASA, but the consequences are not as severe. Overdose may only give nausea, vomiting, and abdominal pain with some nystagmus or headache. If the patient is asymptomatic at 4 hours post-ingestion, DISCHARGE.
IRON OVERDOSE
Iron overdose results in CAPILLARY LEAK, hypotension, ANION GAP ACIDOSIS (mudpiles), AND possible cardiovascular collapse. There may also be associated hematemesis, scarring of the gastric pylorus, and hepatic toxicity. On presentation, obtain ABDOMINAL X-rays to look for undigested pills. There are 4–5 stages of toxicity (GI, Latent, Metabolic/Cardiovascular, Hepatic, and then Delayed). Obtaining serum iron levels at about 3–5 hours post-ingestion helps determine the risk of systemic toxicity. Treatment requires CHELATION with DEFEROXAMINE for levels > 500 mcg/dL. Do NOT pick charcoal because it does NOT bind well to iron. Chelation will result in pink urine, often referred to as “Vin Rose Urine.” Continue giving deferoxamine until the urine is no longer pink.
MNEMONICS: DE-FERO. The word says it all. It is used to DE-iron, or DE-FERROus the body. Again, do not choose charcoal. Imagine pouring powdered charcoal onto a shiny iron. It does NOT stick, but it does make a mess on your ironing board.
MNEMONIC: The mnemonic below summarizes the stages of iron overdose.
- I = Indigestion (nausea, vomiting, abdominal pain, and possible hematemesis)
- R = Recovery
= Cardiovascular collapse and liver damage- N = Narrowing of pylorus or other parts of GI tract and causing obstruction from strictures/scars
(DOUBLE TAKE) LEAD TOXICITY
Lead toxicity often arises because kids love lead’s sweet taste. Sources of lead toxicity are paint in old homes and dust from home renovations. Because lead blocks iron from being incorporated into heme, lead toxicity can look very much like iron-deficiency anemia (MICROcytic). To differentiate this from iron deficiency, look for BASOPHILIC STIPPLING of RBCs, constipation, neurologic issues and LEAD LINES (obtain imaging of long bones). Check a lead level at 12 and 24 months of age. Even mild elevations (a level of 5–20) can cause neurologic problems with learning and behavior. For mild elevations, make changes in the home and educate the family. For levels > 45, CHELATION therapy is needed for lead poisoning with edetate disodium calcium (EDTA), dimercaprol or d-penicillamine. Always confirm an elevated capillary sample with a VENOUS sample because these are more reflective of RECENT exposure.
PEARL: Iron levels should be normal and TIBC should be normal or low.
IMAGE: (Lead Lines) – www.pbrlinks.com/LEADTOXICITY1
IMAGE: (Basophilic Stippling) – www.pbrlinks.com/LEADTOXICITY2
IMAGE: (Lead Lines) – www.pbrlinks.com/LEADTOXICITY3
MNEMONIC: The treatment for lead is “LEADetate.”