Desferrioxamine
Liverpool Hospital Emergency Department
Indications for use – Iron toxicity
- Severe systemic toxicity – Metabolic acidosis, shock, GI bleeding, coma
- Peak serum iron >90micromol/L (>5mg/L) at 4-6hr
- Convincing ingestion >60mg/kg with symptoms and evidence on XR if tablet formulation
Formulation 500mg vial:
- Reconstitute the 500 mg powder with 5 mls sterile water for injection and dilute to 100 mls with 5% glucose or 0.9% normal saline
Dosage and Administration
- Discuss with Toxicologist
- 15mg/kg/hr IV Infusion to maximum 90mg/kg/24hrs
- Rate increased to maximum 35mg/kg/hr if required (persistent instability)
- Dosage same for Adults, Children and in Pregnancy.
- Severe renal impairment -> 50% dose reduction
- Do not use beyond 24hours unless toxicology guided
- Cardiac monitoring mandatory
Treatment aim = Iron Level <60mmol/L + improving metabolic status
Consultation with toxicologist prior to cessation
Adverse Effects
- Hypotension/flushing/urticaria (Histamine release)
- Orange-Red urine (chelated Iron)
- ARDS/Respiratory toxicity if prolonged use >24hrs
- toxic retinopathy
- Yersinia sepsis (the ferrioxamine complex is a siderophore that promotes growth)
Pit Falls
DO NOT BE FOOLED BY +6-24hr Asymptomatic window
- Multifactorial shock – Adequate fluid +/- blood products in GI Bleeding
- Consider whole bowel irrigation in significant ingestions
- Consider Endoscopy for tablet removal ?Laparotomy for pharmacobezoar removal
- Infusion related hypotension -> IV Fluids usually corrects
- Consider NAI in children
- Mental health schedule in adults