Gebelikteki Demir İntoksikasyonunda Deferoksamin Tedavisi
Erişkinlerdeki demir zehirlenmeleri genelde, intihar amaçlı veya gebelik sırasında destek tedavi amacıyla kullanılan demirin aşırı dozda alınmasıyla gerçekleşir ve son organ hasarlarına neden olabilir. Klinik seyirde hastanın demir alım zamanı, aldığı demir preparatının türü ve semptomların başlangıç zamanı tedavi şemasının belirlenmesinde yol göstericidir. Başlangıç tedavileri çoğunlukla destek tedavi yaklaşımlarından ve demirin bağırsak irrigasyonu ile vücuttan uzaklaştırılmasından ibarettir. Plasentayı geçmeyen ve teratojenik etkileri olmadığı savunulan deferoksamin akut demir zehirlenmelerinde hayat kurtarıcı olabilir. Bu vaka sunumunda gebeliğin 2. trimesterinde intihar amaçlı aşırı dozda oral demir preparatı alan hastanın, İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi Erişkin Yoğun Bakım Ünitesi'ndeki (YBÜ) deferoksamin tedavi yaklaşımı anlatılmıştır
Deferoxamine Treatment of Iron Intoxication During Pregnancy
The main causes of iron poisoning adults include suicide attempts or iron overdose during pregnancy and it may cause end organ failure. Time of the patient's iron intake, the type of the iron preparation and the onset of symptoms are guiding for determining the treatment scheme. Initial treatment approaches mostly consists of supportive treatment and removal of iron from the body with bowel irrigation. Deferoxamine which doesn't cross the plasenta and advocated as nonteratogenic may be lifesaving in acute iron poisoning. In this case report we aimed to present acute iron intoxication of a parturient at her 24 weeks of her gestation, due to suicidal ingestion of elemental iron and she approached deferoxamine as treatment in Istanbul Kanuni Sultan Süleyman Treatment and Research Hospital' s Adult Intensive Care Unit (ICU)
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- Chen MR, Lin JL, Liaw SJ, et al. Acute iron intoxication: A case report with ferric chloride ingestion. Zhonghua Yi Xue Za Zhi (Taipei) 1993; 52:269-72.
- Tran T, Wax JR, Philput C, et al. Intentional iron overdose in pregnancy-management and outcome. The Journal of Emergency Medicine 2000; 18:225- 28.
- Rayburn W, Aronow R, DeLancey B, et al. Drug overdose during Pregnancy: An overview from a metropolitan poison control center. Obstetrics & Gynecology, 1984; 64:611-14.
- Geraci MJ, Heagney H. Iron overdose during pregnancy: International Journal of Clinical Medicine 2012; 3: 715-21.
- Skoczynska A, Kwiecinska D, Kielbinski M, et al. Acute iron poisoning in adult female. Hum Exp Toxicol 2007; 26:663-66.
- Tenenbein M. Hepatotoxicity in acute iron poisoning. J Toxicol Clin Toxicol 2001; 39:721-26.
- Robertson A, Tenenbein M. Hepatotoxicity in acute iron poisoning. Hum Exp Toxicol. 2005; 24:559-62.
- Chyka PA, Butler AY, Holley JE. Serum iron concentrations and symptoms of acute iron poisoning in children. Pharmacotherapy 1996; 16:1053-58.
- Curry SC, Braitberg G. Poisoning in pregnancy. In:Foley MR, Strong T,eds. Obstetric Intensive Care. Philadelphia, WB Saunders 1997; 21:347-67
- American Academy of Clinical Toxicology, European Association of Poison Centers and Clinical Toxicologists: Position Paper: Whole Bowel Irrigation. J Toxicol Clin Toxicol 2004; 42:843-54
- Mills KC, Curry SC. Acute iron poisoning. Emerg Med Clin North Am 1994; 12:397-413
- Fine JS. Iron poisoning. Curr Probl pediatr 2000; 30:71-90
- Tran T, Wax JR, Philput C et al. Intentional iron overdose in pregnancy-managment and out-come. J Emerg Med 2000; 18:22-28
- Jensen CE, Tuck SM, Wonke B. Fertility in ? thalasemia major:a report of 16 pregnancies, preconceptual evaluation and review of the literature. Br J Obstet Gynaecol 1995; 102:625-29.
- Singer ST, Vichinsky EP. Deferoxamine treatment during pregnancy:Is it harmfull?. American Journal of Hematology 1999;60:24-26
- Athanasiou A, Shepp MA, Necheles TF. Anaphylacic reaction to deferoxamine. Lancet.1977; 2:616
- Blanc P, Hryhorczuk D, Danel I. Deferoxamine Treatment of Acute Iron Intoxication in pregnancy. Obstetrics & Gynecology 1984; 64:12-14.
- Cohen AR, Mizanin J, Schwartz E. Rapid removal of excess iron with daily, high-dose intravenous chelation therapy. J Pediatr. 1989; 115- 55
- Bergeron RJ, Wiegand J, Brittenham GM. HBED ligand: preclinical studies of a potential alternative to deferoxamine for treatment of chronic iron overload and acute iron poisoning. Blood 2002; 99:3019-26