Objective: In theory, WBI (whole bowel irrigation) is indicated in iron poisoning, but the existing data are still insufficient to support or exclude its efficacy.
Case report: A 46 year-old female admitted to the Toxicology Department due to suicidal ingestion of 5000 miligrams of elemental iron (57 mg/kg) in sustained-release preparation. WBI was instituted at 2 hours after ingestion, because abdominal X-ray showed mass of tablet material inside stomach and past pylorus. After 3-hour WBI subsequent X-ray revealed residual opacities in small intestine. Levels of serum iron were increasing 289 μg/dL on admission, (1,5 h post ingestion) 408 μg/dL (6 h after ingestion), 424 μg/dL (after 12 h). WBI was continued within 7 hours, until there was no radiographic evidence of toxin remaining in the gastrointestinal tract and clear rectal effluent was apparent. Subsequent serial serum iron concentrations were as follows: 389 μg/dL (after 14 h), 239 μg/dL (after 21 h), 119 μg/dL (after 36 h). Since the patient was asymptomatic did not undergo deferoxamine therapy. Patient recovered without sequelae.
Conclusion: WBI seems to be beneficial in early stage of iron intoxication ensuring rapid and effective cleansing of gut, and decreasing toxin absorption. Authors believe that the use of early WBI allows to provide supportive care and avoid deferoxamine treatment.
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