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4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katiha...

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Drug

Treatment Details

Iron

Route : Ingestion

Fatal dose : 20 to 30 g.

Fatal Period : 24 to 30 hours

Mechanism of action : Increased capillary permeability, post-arteriolar dilatation, release of hydrogen ions, inhibition of mitochondrial function and corrosive action on gastric mucosa. Unbound iron combines freely and circulates within the cells and disrupts physiological mechanisms.

Clinical picture : They are divided into four stages. Few hours after ingestion` vomiting, abdominal pain and haemorrhagic gastroenteritis, shock, acidosis and coma occur. The second stage sets in 6-24 hours in which the patient is symptom-free. In the third stage {24 to 48 hours} metabolic acidosis, jaundice, hypoglycaemia, shock, coma with hepatic and renal failure occurs. After one or two weeks, in the fourth stage, late complications such as gastric stricture and pyloric stenosis occur.

Treatment : 1} Stomach wash with 5 percent sodium bicarbonate solution. Instill 5-10 gm. of desferrioxamine at the end of lavage.
2} Give plenty of egg and milk to form iron-protein complexes.
3} Magnesium hydroxide 1 percent solution orally.
4} Desferrioxamine 1 g. i.m. followed by 500 mg. fourth howebsitey for 2 doses and finally 500 mg. 4 to 12 howebsitey up to a maximum of 6 g. in 24 hours. It can also be given in infusion 15mg, kg, hr in normal saline.
5} Haemodialysis or exchange transfusion in severe cases.

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Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

No, it should be used only after drug sensitivity report

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