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Intravenous ferric carboxymaltose is indicated for iron deficiency when oral preparations are ineffective or not tolerated (Australian Prescriber 2011; 34:119-123)
Administered intravenously, it is effective in the treatment of iron-deficiency anaemia, delivering a replenishment dose of up to 1000 mg of iron during a minimum administration time of less-than or equal to 15 minutes (Lyseng-Williamson KA, Keating GM, 2009).
Iron sucrose is funded by the PBS for IDA only in patients with chronic kidney disease who are having erythropoietin- stimulating agent and react systemically to iron polymaltose
Iron polymaltose has been identified as well tolerated with minor infrequent side effects during infusion and some self-limiting side effects that occur up to two days after infusion. Despite this, the risk of a severe anaphylactic reaction is present and must be considered. An average total-dose infusion of iron polymaltose (sufficient to replenish iron stores, commonly 1000 mg to 2500 mg for adults), given at the rates recommended in Australian approved product information, takes around five hours. Surveys of policies at different health services show a broad range of infusion and premedication practices. Published evidence of delivery of total dose iron polymaltose infusions at accelerated rates is limited. Use of iron polymaltose outside of Australia and New Zealand is also limited (Pasricha et al. 2011)
Approximate cost
PBS $41.00 per 1 x 10 mL vial (500 mg total)
($8.20 per 100 mg)
PBS $41.00 per 5 x 5 mL ampoules (500 mg total)
($8.20 per 100 mg)
PBS $19.55 per 5 x 2 mL ampoules (500 mg total)
($5.99 per 100 mg)
Dosage
A single infusion of 1000 mg over 15 minutes
OR
A single IV bolus dose of 200 mg/day NOT more than three times per week
Most adult CKD patients will require a minimum cumulative repletion dose of 1000 mg of elemental iron to achieve a favorable hemoglobin (Hb) response and to replenish iron stores
See Iron polymaltose suggested infusion rates and observation options listed below
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Iron polymaltose
The following information applies to iron polymaltose only.
Indications
Treatment of iron deficiency anaemia:
when there is demonstrated intolerance, non-compliance or lack of efficacy with oral iron, despite modification of dose, timing and frequency
in patients undergoing chronic haemodialysis and who are receiving supplemental erythropoietin therapy.
Key points
A written intravenous order by an appropriate medical officer must be obtained.
A medical officer need not remain with the patient but should be readily available.
Iron infusions should not to be administered out of hours unless urgently required and medical staff are available.
The iron infusion must be used within 24 hours of preparation.
Contraindications
Contraindications include:
history of allergic reaction to iron polymaltose
anaemia not caused by simple iron deficiency
iron overload
chronic polyarthritis
infectious renal complaints in acute phase
uncontrolled hyperparathyroidism
decompensated hepatic cirrhosis, infectious hepatitis
patients with severe inflammation or infection of the kidney or liver as iron tends to accumulate in inflamed tissues
first trimester of pregnancy
bronchial asthma.
Precautions
Patients with the following conditions may be at a higher risk of adverse reactions:
low iron binding capacity
folic acid deficiency
history of allergic disorders
hepatic insufficiency
cardiovascular disease
rheumatoid arthritis and other rheumatological inflammatory disease.
Pre-infusion assessment
The patient must be educated about possible adverse reactions both immediate and delayed (refer to Adverse reactions).
Establish patent IV access.
Ensure the resuscitation equipment and emergency drugs are accessible and/or presence of hospital medical emergency/code blue policy.
Ensure the patient’s call bell is within reach and instruct them to use it should they become aware of any adverse reaction throughout the infusion.
There is no requirement for routine premedication for patients with no history of adverse reaction to iron infusion; however, if required, premedication should be prescribed according to your health service’s policy and administered at least 30 minutes prior to the commencement of the iron infusion.
Management of infusion
An infusion pump must be used to administer iron infusions.
Do not add any other medications to infusion or mix in the same line.
Follow the hospital guideline for checking the preparation and patient before commencing the infusion.
Working oxygen/suction equipment must be available.
Suggested infusion rates and observation options
Option
Iron polymaltose dose in (sodium chloride 0.9%)
Duration of infusion
Initial infusion rate
If initial infusion tolerated increase infusion rate to:
A
500 mg
1000 mg
1500 mg in 250 mL
80 minutes
rapid infusion
40 mL/hour for 15 minutes
Observations every 5 minutes
250 mL/hour
Observations every 15 minutes
Observations include: pulse, temperature, blood pressure and SaO2
B
500 mg
1000 mg
1500 mg in 250 mL
2.5 hours
40 mL/hour for 15 minutes
Observations every 5 minutes
125 mL/hour
Observations every 30 minutes
C
500 mg
1000 mg
1500 mg in 250 mL
5 hours
40 mL/hour for 15 minutes
Observations every 5 minutes
60 mL/hour
Observations every 30 minutes
D
*2000 mg in 500 mL
2.5 hours
40 mL/hour for 15 minutes
Observations every 5 minutes
250 mL/hour
Observations every 30 minutes
E
*2000 mg in 500 mL
5 hours
40 mL/hour for 15 minutes
Observations every 5 minutes
120 mL/hour
Observations every 30 minutes
Table developed from the Western Health Iron Infusion procedure, and the Fremantle Hospital and Health Service Iron polymaltose specialised drug guideline (which is no longer accessible online).
*Average total-dose infusion of iron polymaltose (sufficient to replenish iron stores, commonly 1000-2500 mg for adults). Facilities providing information to assist with preparation of these guiding principles have policies that allow no more than 2000 mg in a single dose.
If there are concerns at any time during the infusion or an adverse reaction appears likely, stop the infusion and call for medical support.
Adverse reactions
Acute - during infusion
Delayed – 1 to 2 hours post infusion
Delayed – 1 to 2 days post infusion
Uncommon
Very unusual
Very unusual
Sensations of warmth or itching, especially in axilla and groin
Mild erythematous or urticarial rash
Dizziness
Chest pain/occasional arrhythmias
Dyspnoea
Nausea
Headache
Fever, usually hours/days post-infusion
Arthralgia/myalgia
Headache
Mild fever
Joint and muscle aches
These symptoms generally resolve without treatment. They are more common with ‘total dose’ infusions of iron polymaltose.
Note: Patients should be instructed that if they experience chest pain, difficulty breathing, dizziness or neck/mouth swelling, they need to seek urgent medical attention/call an ambulance (000).
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References
Diagnosis and management of iron deficiency anaemia: Pasricha, Flecknoe-Brown, Allen, Gibson, McMahon, Olynyk, Roger, Savoia, Tampi, Thomson, Wood and Robinson
Management of iron deficiency in patients admitted to hospital: Ahmed and Gibson
Safety and tolerability of intravenous ferric carboxymaltose in patients with iron deficiency anemia: Bailie, Mason and Valaoras
Efficacy and safety of ferric carboxymaltose in correcting iron-deficiency anemia: Bailie, George R
DEDICATES TO MY KIDS TO MY BROTHER SIPPA SISTER DARKANGELXX MY PARTNER MY PETS AND EVERYONE WHO I LOVE NOW AND WHO I HAVE EVER LOVED INCLUDING MY MOM LISA AND GRANDFOLKS,WHO ARE NOW BACK IN SPIRIT.
DEDICATED ALSO TO HAMBONES MY DOG,AND TO MY SWEET CATS TUPPYKINS AND RAVEN MIAOWS WHO HAVE PASSED HOME TO RAINBOW BRIDGE.
DEDICATED TO ALL MY ANIMALS WHO ARE WAITING FOR ME AT RAINBOW BRIDGE AND FOR THE PEOPLE I LOVE WHO HAVE RETURNED HOME TO SPIRIT.IT ITS NEVER GOODBYE. BUT IS ONLY GOODNIGHT, SEE YOU IN THE MORNING.ONE FINE DAY. LOVE YOU ALL BUNCHES.
5 THINGS CATS CAN SENSE FROM WWW.CATTITUDEDAILY.COM
12:53 Sep 03 2020 Times Read: 725
Our cats have some pretty amazing qualities. Their reflexes are astounding, their senses—excluding vision—are far superior to our own, and it seems that there’s a strange sixth sense that cats seem to possess that we sometimes cannot explain. While dogs and other animals sometimes seem to have superpowers in which we cannot fully comprehend, our feline friends are probably most profound in their ability to sense things in which we can’t. Here’s my list of five incredible things that cats can sense.
Cats can sense bad weather—and even natural disasters!
Your cat’s whiskers are their twitchy mood receptors on either side of their face. They have the ability to detect even the slightest of movements with ease. So, how is it that cats seem to predict bad weather? Well, I’d bargain that a lot of it has to do with the changes in air pressure that they can sense. It’s also been predicted that your cat’s ears can sense the changes in atmospheric pressure as well, or that they can even smell the changes in the air.
things cats can sense
Cats can sense who need them most.
I’ve always personally believed that cats have a strange gift for knowing the people who need them most in life. I adopted my cat Tom when I was at a very low point in my life, dealing with the impending diagnosis for my son who is nonverbal and autistic. Tom was once a street cat that had been trapped and sat waiting to be adopted, consistently passed over for his skittish nature. The two of us have a bond like I have never had with a cat, as he knows when I need him most.
Many cats are this same way for their owners, too. And there are many times in which cats have simply showed up and chosen their humans. Call it fate or destiny or whatever you’d like, but I believe that cats have a sixth sense for knowing who needs them most in life—and making themselves a part of that person’s life for good.
Cats can sense things like death, spirits, and ghosts.
This one might be a hot topic for those who like to argue that spirits and ghosts are not real. And that’s fine. But I know for a fact that cats can sense impending death, because a cat in Rhode Island named Oscar had an entire book written about the incredible acts he did.
Making Rounds with Oscar: The Extraordinary Gift of an Ordinary Cat details one ordinary cat who possessed a truly extraordinary capability: the ability to know when a person at the nursing home in which he lived was set to make their passage to the other side. And it’s not like Oscar just did this once or twice. He did it over 50 times. And just as cats have been recorded as predicting death, some have forecasted new life, too, by predicting pregnancy.
Cats can sense danger
There have been many stories of dogs saving the day—but cats have certainly served as heroes, too. Joey, a cat in Canada, woke up out of nowhere and alerted his family of a fire in the kitchen. And another cat in South America even saved a baby from tumbling down a flight of stairs.
My own cat Tom chased my then-two-year-old son down the driveway as he was running out to the street, preventing him from running in front of a moving vehicle as I chased after them. There are a great many stories of cats becoming heroes, and it just goes to show you that the love and loyalty of a cat is something that should never, ever be taken for granted. Because it serves as the very definition of “who rescued whom” in profound ways.
things cats can sense
Cats have detected cancer in humans.
In defense of canines, there have been plenty of dogs who have miraculously informed their masters of cancer. And regardless of whether it’s a cat or a dog that has done this, it’s truly an incredible act in my opinion. I’ve read and heard many stories of pets alerting their owners that something could be seriously wrong with their health. My own mother-in-law had a giant brown tabby named Tigger when I first met her, which she credited for alerting of her cancer.
Tigger started acting very strangely, a usually aloof cat that was more of a lingerer and not much for cuddling or kneading. Then, shortly before I had met her, she told me that he would jump up on her lap when she was on the sofa watching TV and begin pawing fiercely at her stomach.
She didn’t know why he was doing this, as this sort of behavior was completely out of the norm for him. After he kept repeating the behavior day after day, she thought maybe she should go and get checked out because she was feeling tired out of the blue. Well, thankfully she did, because she was diagnosed with stage 2 colon cancer. And she was able to beat it with chemotherapy treatments since it was not further advanced. And not long after, Tigger crossed the Rainbow Bridge. But not after saving his human’s life first.
If you’ve ever been to England, you know there is no shortage of unique pubs. From the high-end money makers to the locally-owned holes in the wall, there are plenty of places to wet your whistle. Bag of Nails Pub in Bristol, however, definitely stands out. At first glance, this bar has all the staples—great beer, music, and good company. Take a step inside, however, and you’ll see it has even more. The pub is also home to 14 cats. Owner Luke Daniels is unapologetic about the pack of felines that helps run his business, and the cats are helping put the place on the map.
Daniels told the Bristol Post that he never intended to run a cat-friendly pub. It happened almost by accident when he agreed to temporarily care for a friend’s pet. That one cat, named Malcolm, ended up staying. And as we all know, once you have one cat, you can’t say no to more.
Now eight years into his role as Bag of Nails owner, Luke has 14 cats that call the pub home. While he admits his pub isn’t for everyone, his pack of cats has turned the place into a type of tourist attraction. There are the locals that come to the pub for the beer and atmosphere as well as travelers who can’t resist the allure of socializing in a British pub with a cat or two lounging nearby.
All of the Bag of Nails cats have their own stories and came to the pub under different circumstances. They also all have names, and it’s a challenge for locals to learn and recognize each individual feline. With more than a few identical-looking litter mates, it’s not such an easy task.
Jove and Luna, for example, are tabby siblings with stunning swirls in their coat patterns. The best way to tell them apart is to look for their eyes. Luna suffered an eye injury before she came to the pub that required extensive treatment.
Another tabby named Philomena (of Charlie Brooker fame), made herself at home in the pub when her mother carried her there from a nearby park during a storm. The pub turned into a safe haven, and now Philomena enjoys all the attention. You’ll know it’s her, however, because she’ll refuse to sit in your lap. She prefers to receive pets on her own terms.
By the time a tabby boy named MonkeyFace came around, Luke was running out of ideas for names. But the friendly guy was still welcomed to the family. Like most cats, he enjoys sitting in a good box and getting head scratches.
There are a few of the Bag of Nails cats that prefer favored hiding spots to mingling with crowds, but most of the cats make an appearance on a daily basis. The pub made it through lockdown thanks to their popular takeaway beer service, and the cats are now pleased to welcome back their favorite patrons—with restrictions, of course.
Unless it’s peak hours, there’s a good chance there are more cats enjoying this local pub than humans. And when we think about it, that doesn’t sound half bad.
Featured photos via Facebook/ Bag of Nails, Bristol
COMMENTS
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ShatteredAura
16:24 Sep 30 2020
I love music like this!!