Desferrioxamine

Desferrioxamine is an effective iron chelator that is used to treat systemic iron toxicity or prevent the development of systemic toxicity following acute iron overdose. It should ideally be given before iron moves intracellularly and systemic toxicity develops.


Indications

  • Systemic iron toxicity: Severe gastroenteritis, shock, metabolic acidosis and altered GCS
  • Iron levels >90 micro mol/L or 500 microgram/dL at 4-6 hours post ingestion
  • Chronic iron overload

Administration

  • Cardiac monitoring is required.
  • Reconstitute 500mg of powder with 5ml of sterile water and dilute in 100ml of 0.9% saline or 5% dextrose.
  • Commence IV infusion at an initial dose of 15 mg/kg/hour. Can be reduced if hypotension develops.
  • The rate may be increased in life-threatening toxicity up to 40 mg/kg/hour if blood pressure allows.
  • Continue the infusion until the patient is clinically stable and the serum iron <60 micro mol/L (350 microgram/dL), but avoid infusion >24 hours (6 hours is usually sufficient).
  • Paediatric Dose = same as for adults

Adverse Reactions:

  • Hypersensitivity
  • Hypotension
  • ARDS (for infusions >24 hours)
  • Toxic Retinopathy
  • Infection (Yersinia and mucormycosis grow avidly with the ferrioxamine complex)
  • Rose urine – classical sign but does not necessarily indicate effective chelation.

References

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Toxicology Library

Antidote

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Burnaby Hospital in Vancouver Emergency. Loves the misery of alpine climbing and working in austere environments. Supporter of FOAMed, toxicology, tropical medicine, sim and ultrasound

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