铁过量导致的急性肝衰竭(2005.2)

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Acute Liver Failure Due to Iron Overdose in an Adult.
Southern Medical Journal. 98(2):241-244, February 2005.
Daram, Sumanth R. MD; Hayashi, Paul H. MD
Abstract:
The vast majority of acute iron toxicity cases occur in children less than 5
years of age. Moreover, clinical hepatic injury is uncommon with most
symptoms stemming from the intestinal tract (eg, nausea, vomiting,
diarrhea). Therefore, physicians, particularly those who do not routinely
treat pediatric patients, are often unfamiliar with hepatotoxicity related
to iron overdose. Nevertheless, hepatotoxicity caused by acute iron
poisoning is associated with a high mortality rate. We report a case of
severe hepatic injury in an adult who overdosed on iron tablets with
suicidal intent. Tests for other hepatotoxins (eg, acetaminophen),
hepatatrophic viruses, and other causes of acute liver injury were negative.
Although peak serum iron level (340 [mu]g/dL) was significantly lower than
that reported to cause hepatotoxicity (>1,700 [mu]g/dL), rapid and
significant elevations in aminotransferases (>4,000 U/L), total bilirubin (5
mg/dL), and prothrombin time (50 seconds) occurred within 48 hours.
Treatment with deferoxamine was prompt and followed by empiric
N-acetylcysteine once liver injury was apparent. The patient was minimally
symptomatic and she eventually had a full recovery.