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- syrup of Ipecac technique ไมแนะน า และไดประโยชนคอนขางนอย
- Gastric lavage ใหประโยชนมากกวาการกระตนใหอาเจยนแตกถกจ ากดได ถา Iron tablet มขนาดใหญและปรมาณ iron tablet มจ านวนมาก
- Whole bowel irrigation จากการศกษาใน case report พบวาไดประโยชน
Polyethylene glycol (Colyte, GoLYTELY) ใหทาง nasogastric tube at 500 mL/h for children and up to 1.5–2 L/h for adults.ใหจนกวาจะอจจาระใส; ไมพบradiopacities.
พจารณาendoscopic or surgical removal of Fe-containing bezoar if unresponsive to irrigation.
-Intravenous Deferoxamine o Deferoxamine 100 mg จะ Chelate ferric ion 8.5 mg o ควรใหทนทภายใน 24 ชวโมง
-ขอบงชในการให
Metabolic acidosis repetitive vomiting or diarrhea toxic appearance: lethargy, hypotension, or signs of shock serum iron concentration >500 μg/dl ให Deferoxamine IV ในผปวยทม อาการแสดงของ ภาวะเหลกเปนพษทรนแรง ควรให intravenous Deferoxamine
infusion 15 mg/kg/h
-Administration techniques:
Increase IV infusion rate to 15 mg/kg/hr over 20 min, monitoring for hypotension. ลด infusion rate ถาม hypotension Infusion rates as high as 45 mg/kg/hr have been tolerated. Disregard manufacturer’s recommendation of maximum daily doses of 6 g in serious iron
GI symptoms or dehydration Patients treated with Deferoxamine ICU admission for coma, shock, metabolic acidosis, or iron levels >1,000 mg/dL
Discharge Criteria
Asymptomatic with negative radiograph Minimal to no symptoms after 6-hr observation Mild GI symptoms that have resolved without evidence of metabolic acidosis and serum iron <350
mg/dL
IRON KEY POINTS
Asymptomatic at 6hrs r/o significant ingestion 5 stages Must consider with gastro, GI bleed, AGMA, shock NYD Absence of pills on AXR does not r/o Rx based on signs/symptoms/labs + iron level + amount ingested Don’t wait for level if patient toxic
เอกสารอางอง
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