Iron Poisoning and the Utility of Continuous Renal Replacement Therapy (CRRT)
- Hemodialysis: Case Reports, Series, QI Projects
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 801 Dialysis: Hemodialysis and Frequent Dialysis
- Sheikh, Omer, The Ohio State University, Columbus, Ohio, United States
- Yau, Amy, The Ohio State University, Columbus, Ohio, United States
- Chung, Madeline S., The Ohio State University, Columbus, Ohio, United States
Iron poisoning is a rare life-threatening condition. The primary method for iron removal remains chelation therapy, and continuous renal replacement therapy (CRRT) should be utilized as an adjunctive therapy. We describe a case on the role of RRT in iron chelation for severe iron poisoning.
An 18 Year old man with unremarkable past medical history presented to the hospital with intentional overdose secondary to ibuprofen and iron. He was initiated on chelation agent, deferoxamine, and referred to our center for transplant evaluation. Initial iron profile was significant for an iron level of 320 ug/dL. Peak iron levels of > 3000 ug/dL were seen 3 hours after presentation and trended to < 90 ug/dL 48 hours after presentation. Baseline serum creatinine of 0.5-0.8 mg/dL, and at the time of his presentation was 0.78 mg/dL and so toxicology recommended initiation of CRRT to ensure deferoxamine clearance. Imagining studies did not demonstrate iron deposits in the kidneys. 5 days after ingestion, the patient successfully underwent hepatitis C virus positive orthotopic liver transplant. He was eventually liberated from renal replacement therapy 7 days after initiation.
This case highlights the important supportive role of CRRT in the management of iron overdose. Iron poisoning can lead to significant hemodynamic instability, including hypotension and fluid shifts and it can also lead to direct toxic effects. Iron poisoning can also lead to electrolyte derangements such as hyponatremia, hyperkalemia, or metabolic acidosi. In both instances, CRRT helps maintain fluid balance by allowing for precise control of fluid removal, replacement, and electrolyte adjustments. Additionally, chelating agents are mostly excreted in the urine unchanged. In cases where iron chelation therapy is utilized, especially if there is any renal impairment, CRRT can assist in removing the chelating agent from the bloodstream and preventing its accumulation and potential adverse effects. Of note hepcidin and pro-hepcidin have molecular weights of 2.7 KDa and 10 KDa, respectively, and, therefore, may be removed by CRRT, which uses membranes with a cut-off of 35 KDa. Nephrologists should be liberal in the use of CRRT especially if patients are receiving chelation therapy or have any degree of renal insufficiency.