Appetite With Iron Overdosage

Capsule: Retinol (Vitamin A): Acute ingestion of more than 12,000 IU/kg is considered toxic. Chronic ingestion of more than 25,000 IU/d for 2-3 weeks may produce toxicity. Acute toxicity causes rash, abdominal pain, increased intracranial pressure, and vomiting. Chronic toxicity causes rash, increased intracranial pressure, sparse and coarse hair, dry and rough skin, and arthralgia; risk of fractures is increased, especially in the elderly.
Cholecalciferol (Vitamin D₃): Acute ingestion is highly unlikely to produce toxicity. In children, chronic ingestion of more than 5,000 IU/d for several weeks may result in toxicity (adults >25,000 IU/d). Despite its safety, excessive use can lead to vitamin D toxicity, which manifests with nausea, vomiting, decreased appetite, fatigue, weight loss, constipation, dehydration, irritability, and confusion. Those symptoms are still observable for more than two months after drug discontinuation and largely derive from the effects of hypercalcemia.
Acute intake of large doses of water-soluble vitamins is readily excreted in the urine. No emergency procedure or antidote is applicable, and any symptoms are rapidly reduced upon withdrawal of the preparation. However, the following adverse reactions have been reported: Thiamine (Vitamin B₁): Thiamine doses of 5 mg/day for 4 to 5 weeks may cause headache, insomnia, irritability, increased heart rate, and weakness.
Riboflavin (Vitamin B₂): Large doses of riboflavin result in a bright yellow discoloration of the urine that may interfere with certain laboratory tests.
Nicotinamide (Vitamin B₃): An intake of 3,000 mg/day of vitamin B₃ may cause nausea, vomiting and signs of liver toxicity.
Pyridoxine (Vitamin B₆): Reversible sensory neuropathy has been reported with chronic intake of high doses of vitamin B₆; the dose at which these occur is controversial.
Cyanocobalamin (Vitamin B₁₂): High doses of cyanocobalamin are generally not associated with toxicity although rare allergic and anaphylactic reactions and mild diarrhea have occurred.
Ferrous sulfate (Iron): Iron overload may result to pigment deposition in skin and other organs, mild liver dysfunction, endocrine dysfunction, heart disease and severe damage to the gastrointestinal tract.
Oral intake of 20 to 60 mg/kg elemental iron may or may not produce serious toxicity symptoms. Oral doses of 40 to 60 mg/kg are associated with serious toxicity. Fatality has been reported with doses 60 to 300 mg/kg.
Iron toxicity clinically manifests in five overlapping phases. The first is the gastrointestinal phase that occurs 30 mins to 6 hours post ingestion. Clinical presentation results from direct injury to the gastrointestinal mucosa and may include abdominal pain, vomiting, diarrhea, hematemesis, melena, and lethargy. The next phase is the latent phase or the relative stability phase which occurs after 6 to 24 hours. The third phase is characterized by shock and metabolic acidosis and typically occur within 6 to 72 hours post ingestion. Shock may be due to hypovolemia or direct cardiotoxicity. The fourth phase is hepatotoxicity or hepatic necrosis which may be expected within 12 to 96 hours. Hepatocellular necrosis should be suspected when jaundice, bleeding, hypoglycemia, encephalopathy, and positive anion gap metabolic acidosis are evident. Renal failure may ensue with poor tissue perfusion. The fifth phase is bowel obstruction which can present 2 to 8 weeks after ingestion. This result from stricture or pyloric stenosis brought about by gastric scarring. Clinical evaluation together with appropriate laboratory analysis are important in the clinical assessment as there is no single satisfactory method of evaluation of iron toxicity. Determining the serum iron concentration (SIC) approximately 4 to 6 hours after ingestion may be the best laboratory parameters of severity. (See table.)

Click on icon to see table/diagram/image

Elemental iron toxicity should be managed with aggressive supportive care. Whole bowel irrigation should be done whenever possible. Correct metabolic acidosis with adequate fluid resuscitation and administration of sodium bicarbonate. The antidote of choice is intravenous deferoxamine. Deferoxamine should be considered among patients with severe symptoms (altered mental status, hemodynamic instability, persistent vomiting and/or diarrhea), anion gap metabolic acidosis or peak serum iron concentration of 5 mg/L (90 micromol/L) or higher. Hemodialysis may be considered in acute renal failure to facilitate the removal of iron-deferoxamine complexes.
Buclizine: Antihistamine overdose in general can include dizziness, tachycardia, headache, drowsiness, or agitation. While the current generation of lesser sedating antihistamines do not affect the QT interval at normal doses, there are concerns there may be some effect in overdose.
Syrup: Excessive intake of this medicine may cause headache, insomnia, irritability, increased heart rate, weakness, bright yellow urine, nausea, vomiting, signs of liver toxicity, numbness, allergic reactions, diarrhea, abdominal problems, acute renal failure, dizziness, excitability, drowsiness, anxiety, black colored stool, and vomiting of blood.
What to do when the patient has taken more than the recommended dosage: Consult the doctor immediately if the patient experiences any of the signs and symptoms of overdose. (See as previously mentioned.)