Iberet Active Overdosage

Due to the controlled-release nature of the preparation, effects of overdosage could be delayed.
Acute overdosage of iron may cause nausea and vomiting and, in severe cases, hepatic necrosis, cardiovascular collapse, and death. The lethal dose of orally ingested elemental iron is estimated to be 180 to 300 mg/kg of body weight. However, a dose of elemental iron as low as 30 mg/kg may be toxic in some individuals and ingestion of doses as low as 60 mg/kg have resulted in death. In small children, however, it is estimated that as little as 400 mg of elemental iron could be fatal.
Toxicity that occurs with an acute iron overdosage results from a combination of the corrosive effects on the gastrointestinal mucosa and the metabolic and hemodynamic effects caused by the presence of excessive elemental iron.
The signs and symptoms of acute iron poisoning may occur within 10 to 60 minutes or be delayed for several hours. Initial clinical manifestations may encompass acute gastrointestinal irritation, including epigastric pain, nausea, vomiting, diarrhea of green and subsequently tarry stools, melena and hematemesis which may be associated with drowsiness, pallor, cyanosis, lassitude, seizures, shock and coma. Hepatic necrosis and hepatic failure may develop. Because of potential toxic effects of overdosage, immediate medical attention is warranted.
Iron poisoning should be treated by emptying the stomach via ipecac-induced vomiting or preferably, by gastric lavage with a large bore tube. If the patient has experienced multiple episodes of vomiting, especially if the vomitus contains blood, ipecac syrup should not be administered.
Vomitus should be examined for returned Gradumet tablets. If sufficient tablets are not returned, the possibility of whole gut lavage with 0.9% sodium chloride solution plus a saline cathartic should be considered. Surgical removal of iron tablets which are visible in abdominal radiographs may be required if other means of removing the drug are unsuccessful.
The best method for assessing the severity of an iron ingestion is to measure the serum iron and the total iron binding capacity (TIBC). If the serum iron level is greater than TIBC, the potential for systemic toxicity exists. Serum iron and total iron-binding capacity levels may be used as guidelines for use of deferoxamine, an agent used to chelate elemental iron.
Chelation therapy with deferoxamine should be considered when the following conditions exist: 1. A potentially lethal dose (180 to 300 mg/kg or more) of elemental iron has been ingested; 2. Serum iron concentrations are greater than 400 to 500 μg/dL; 3. Serum iron concentrations exceed total iron binding capacity, and/or; 4. Patients have severe symptoms of iron intoxication such as coma, shock, seizure. Hemodialysis of little value in the treatment of iron intoxication.
Supportive treatment, including suction and maintenance of airway; correction of acidosis and control of shock and dehydration with intravenous fluids or blood, oxygen and vasopressors, should be administered as required.
High doses of individual components of the product have been associated with eczematous and exanthematous skin lesions, fatigue and insomnia.
In higher niacinamide doses, liver damage, gout and ulcer formation have been noted.
Vasodilatory effects such as giddiness, faintness, vasovagal attacks and anaphylactic shock have also been reported. In high doses of pyridoxine, peripheral sensory neuropathy and vesicular skin lesions have been reported.
Hemolysis has been reported at high doses of ascorbic acid, especially in patients with glucose-6-phosphate deficiency.