ABSTRACT
Sore throat, earache, and sinusitis are common presenting complaints in the emergency department, and all fall within the top ten in the United States. These complaints usually have a benign course but rarely can be a symptom of a serious disease process. This article provides an evidence-based review of the literature regarding the diagnosis of pharyngitis, otitis media, and sinusitis.
Subject(s)
Earache/etiology , Pharyngitis/etiology , Sinusitis/etiology , Adult , Child , Diagnostic Tests, Routine , Earache/diagnosis , Earache/therapy , Evidence-Based Medicine , Humans , Otitis Media/diagnosis , Otitis Media/etiology , Otitis Media/therapy , Pharyngitis/diagnosis , Pharyngitis/therapy , Sinusitis/diagnosis , Sinusitis/therapyABSTRACT
The ingestion of iron-containing products is a potential toxicologic emergency. The total iron binding capacity (TIBC) has been used widely as a predictor of end-organ toxicity and a guide to the need for deferoxamine therapy. When the TIBC is greater than the serum iron concentration (SIC), it is held that no free iron is present to cause toxicity. The TIBC fails as a marker of toxicity for several reasons. First, the laboratory methods used to measure TIBC are inaccurate in the setting of iron overload. Second, the presence of deferoxamine, the antidote for iron poisoning, has been shown to make the TIBC measurement inaccurate. Third, TIBC measurements have been shown to be variable. Finally, studies and case reports demonstrate toxicity even when the TIBC is greater than the SIC. These shortcomings of the TIBC invalidate it as a predictor of toxicity in iron poisoning.
