Pulmonary toxic effects of continuous desferrioxamine administration in acute iron poisoning

Tenenbein, Milton; Kowalski, S.; Sieńko, Anna; Bowden, D. H.; Adamson, I. Y. R.

doi:10.1016/0140-6736(92)90598-w

Cited by 115 publications

(37 citation statements)

References 12 publications

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“…For example, it may reduce free radical production through lowering iron availability (1) or alternatively increase free radical production (20), possibly through an effect on the expression of heme oxygenase 1 (5). The latter effect may be a particular case of a more widespread regulatory effect of iron on gene expression, which could provide an alternative explanation for the effect of DFO in our experiments.…”

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confidence: 64%

Desferrioxamine elevates pulmonary vascular resistance in humans: potential for involvement of HIF-1

Balanos

Dorrington

Robbins

2002

Journal of Applied Physiology

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Balanos, George M., Keith L. Dorrington, and Peter A. Robbins. Desferrioxamine elevates pulmonary vascular resistance in humans: potential for involvement of HIF-1. J Appl Physiol 92: 2501-2507, 2002. First published February 15, 2002 10.1152/japplphysiol.00965.2001.-Hypoxia-inducible factor (HIF)-1 is stabilized by hypoxia and iron chelation. We hypothesized that HIF-1 might be involved in pulmonary vascular regulation and that infusion of desferrioxamine over 8 h would consequently mimic hypoxia and elevate pulmonary vascular resistance. In study A, we characterized the pulmonary vascular response to 4 h of isocapnic hypoxia; in study B, we measured the pulmonary vascular response to 8 h of desferrioxamine infusion. For study A, 11 volunteers undertook two protocols: 1) 4 h of isocapnic hypoxia (endtidal PO 2 ϭ 50 Torr), followed by 2 h of recovery with isocapnic euoxia (end-tidal PO 2 ϭ 100 Torr), and 2) 6 h of air breathing (control). For study B, nine volunteers undertook two protocols while breathing air: 1) continuous infusion of desferrioxamine (4 g/70 kg) over 8 h and 2) continuous infusion of saline over 8 h (control). In both studies, pulmonary vascular resistance was assessed at 0.5-to 1-h intervals by Doppler echocardiography via the maximum pressure gradient during systole across the tricuspid valve. Results show a progressive rise in pressure gradient over the first 3-4 h with both isocapnic hypoxia (P Ͻ 0.001) and desferrioxamine infusion (P Ͻ 0.005) to increases of ϳ16 and 4 Torr, respectively. These results support a role for HIF-regulated gene activation in human hypoxic pulmonary vasoconstriction. hypoxia inducible factor-1; hypoxic pulmonary vasoconstriction; pulmonary circulation THERE IS EVIDENCE TO SUGGEST that the human pulmonary circulation responds to sustained hypoxia by developing a progressively more intense constriction over a period of a few hours. In anesthetized patients, Fiser et al. (4) observed a gradual decline in pulmonary venous admixture during unilateral atelectasis over 90 min, suggesting that blood flow diversion by hypoxic pulmonary vasoconstriction was intensifying during this time. Exposure of healthy humans to an 8-h isocapnic reduction in end-tidal oxygen partial pressure (PET O 2 ) to 50 Torr, approximately half its normal value, results in a progressive rise in pulmonary vascular resistance (PVR) over 2 h to ϳ2.5 times its euoxic value as determined by right heart catheterization (3).The mechanisms responsible for this slower component of the pulmonary vascular response to hypoxia remain unclear (13,22), but one possibility is that the transcriptional regulator hypoxia-inducible factor (HIF)-1 is involved, as it is in some other homeostatic responses to hypoxia (18). Yu et al. (23) examined the kinetics of induction of increased levels of the subunit HIF-1␣ in isolated ferret lungs exposed to 8 h of hypoxia. They found that HIF-1␣ was not detectable at 0 h, increased at 1-2 h, peaked at 4 h, and remained elevated thereafter (23). Furthermore, the work of Yu et ...

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confidence: 64%

Desferrioxamine elevates pulmonary vascular resistance in humans: potential for involvement of HIF-1

Balanos

Dorrington

Robbins

2002

Journal of Applied Physiology

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“…La naloxona puede generar distintos cambios a nivel cardiorrespiratorio en niños: desde taquipnea, taquicardia e hipertensión arterial hasta algunos casos de edema pulmonar 21 , e incluso parada cardiaca en prematuros extremos 22 . Entre los eventos adversos relacionados con la desferroxamina, destaca el síndrome de distrés respiratorio agudo en pacientes en los que la infusión continua se prolonga más de 24 h [23][24][25] . Este estudio presenta limitaciones: en primer lugar, por su diseño retrospectivo, debemos asumir la pérdida de los datos que no hayan sido registrados en su momento.…”

Section: Discussionunclassified

Uso de antídotos en un servicio de urgencias pediátricas

Sánchez

Hernández

Argullós

et al. 2014

Anales de Pediatría

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“…Significant pulmonary toxicity has been reported following intravenous infusions for greater than 24 h [7,8]. Proposed mechanisms for pulmonary injury include free radical formation and intracellular catalase depletion [9]. Given the patient's markedly elevated serum iron concentration, concern existed regarding the possibility of a lengthy treatment course.…”

Section: Discussionmentioning

confidence: 99%

Severe iron poisoning treated with prolonged deferoxamine infusion: a case report

Wright

Valento

Mazor

et al. 2018

Toxicology Communications

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The incidence of iron poisoning, once the most common cause of fatal pediatric unintentional ingestions, and the use of its antidote deferoxamine have declined. We describe a case of a 17-year-old girl who presented to a hospital following an intentional polysubstance ingestion, which included ferrous sulfate. She developed severe gastrointestinal symptoms including hematemesis, as well as anion gap metabolic acidosis, coagulopathy, and liver toxicity. She was treated with a prolonged course of greater than 24 h with deferoxamine due to a markedly elevated serum iron concentration of 2565 g/dL and worsening clinical status. Clinical features and management of complex iron poisoning are discussed. This case demonstrates the benefit of early poison control center and medial toxicology involvement in instances regarding the off-label usage of deferoxamine in the treatment of severe iron toxicity.

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Pulmonary toxic effects of continuous desferrioxamine administration in acute iron poisoning

Cited by 115 publications

References 12 publications

Desferrioxamine elevates pulmonary vascular resistance in humans: potential for involvement of HIF-1

Desferrioxamine elevates pulmonary vascular resistance in humans: potential for involvement of HIF-1

Uso de antídotos en un servicio de urgencias pediátricas

Severe iron poisoning treated with prolonged deferoxamine infusion: a case report

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