A 4-year-old is admitted to the emergency room after accidentally ingesting a bottle of her mother's iron supplements five hours earlier. Which of the following medications can the nurse expect the physician to order?

Explanation

• Deferoxamine (Desferal) is a chelating agent that removes excess iron from the bloodstream. If this fails, dialysis would be the next step.

The first signs of iron poisoning are stomach pain, nausea and vomiting, and possibly bloody vomiting. Pain may then decline as the iron is digested and absorbed, but this results in metabolic acidosis. Damage to the liver and brain will result, as well as hypovolemic shock due to the potent vasodilating effects of iron. Death can occur from the liver failure.

Incorrect answers:

• Activated charcoal is sometimes used during overdoses to prevent absorption by the GI tract. In this patient scenario, because the patient ingested the iron five hours earlier, the iron is most likely already digested and absorbed, so a chelating agent is required.

• Ipecac was once used as a home remedy to induce vomiting in cases of accidental poisoning. The American Academy of Pediatrics now advises against its use.

• Naloxone is for opioid overdose.

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