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Myocardial Failure and Shock in Iron PoisoningThe Winnipeg Children's Hospital and The University of Manitoba Departments of Pediatrics, Department of Pharmacology, The University of Manitoba, The Manitoba Poison Control Centre, Canada
The Winnipeg Children's Hospital and The University of Manitoba Departments of Pediatrics
Department of Pathology, The University of Manitoba Shock is a well-known complication of iron poisoning. Its aetiology is multifactorial with hypovolaemia due to gastrointestinal blood loss and myocardial depression due to systemic acidosis contributing to its genesis. Primary myocardial dysfunction has not been considered to play a role. Our clinical experiences and autopsy findings in three fatal cases of iron poisoning support myocardial dysfunction and damage as contributing factors to their cardiovascular collapse.
The three patients, all female, were 3 The presence of myocardial dysfunction has therapeutic implications. Patients with severe iron poisoning require early and serial measurements of arterial blood pressure, central venous pressure and cardiac output. If primary myocardial dysfunction is documented then fluid replacement, inotropic support and afterload reduction should be considered.
Human & Experimental Toxicology, Vol. 7, No. 3,
281-284 (1988) |
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, 16 and 28-years-old. Onset of shock occurred at 1, 2 and 5 days post-ingestion. There was no response to vigorous fluid replacement therapy and aggressive catecholamine infusions. Central venous pressures were elevated. Microscopic examination of postmortem tissue showed myocardial damage and the presence of stainable iron. It is speculated that the myocardial depression is mediated by lipid peroxidation of myocyte organelle membranes due to iron catalysed free radical generation.