babybabble ([info]babybabble) wrote,
@ 2005-10-16 17:32:00
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rash thinking (Patri)
so my brain finally turned on today and I asked Shannon for all medications she was taking by mouth. Her rash seems to be a systemic reaction (since its her whole torso, front and back), hence systemic explanations seem likely. The list included both a fish oil supplement that she changed types of a couple days ago, and an iron supplement that she is taking in very large doses to make up for blood loss (157mg/day). Rash is listed as a side effect of IV iron at least, and the dose she's on seems much higher than I found recommended.

I've advised her to switch fish oil supplements, and temporarily discontinue the extra iron, to see if that helps. If so, we can try phasing back in more moderate amounts of iron.


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[info]silona
2005-10-17 05:23 am UTC (link)
sometimes the type of iron is also important in regards to kind rashes.

If I remember correctly taking vitamin c helps with absorption also the source of iron matters...

and oh yes iron can definately be the source of rashes. For me I just changed the kind of suppliment I was using. I'll ask my wholistic doctor what he brand it was. I had a hematocrit of 13... they were shocked i could walk at the time...

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[info]olstad
2005-10-18 02:24 am UTC (link)
Oral doses of iron are bound to be a lot higher than IV because you only absorb 22-33% of the iron in supplements (and remember that the supplement is itself listed as ferrous sulfate/gluconate/fumarate which includes the salt in the molecular weight.) So, high doses of oral iron are not as high as they seem. On the other hand, Shannon is probably anemic from blood loss rather than iron loss, so taking a lower dose for a longer period of time may be better. The goal is to supplement iron because she is rebuilding heme cells which require iron. Some of those heme cells can use her stored iron, but eventually she will become depleted of iron if her stores are used up. And yes, Vitamin C will increase absorption of iron.

As for the rash... is she taking any other medication? If it really is all over her body, she should let the doctor know. There are disease explanations as well as allergic explanations for unexplainable rashes...

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[info]olstad
2005-10-18 02:32 am UTC (link)
Sorry, I didn't read far enough back. Hmmm... Did she use any hospital soaps? Hospital gowns? Did the fish oil thing work? Should I just not ask any more questions? I'm glad you are doing KC. Caleb slept (naked of course) with us for the first several months which I think was very good for all of us. In fact, he still sleeps with us for several hours a night...

And when he was little his favorite place to sleep was on someone. He would wake up whenever we put him down, so he slept on us a lot. I think it makes them (kids) feel more safe and its good for the moms and dads too.

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[info]patrissimo
2005-10-18 06:27 am UTC (link)
Interesting question, I guess she was given some sponge baths in the hospital but that wouldn't be restricted to her torso. And in terms of timing of stimulus, hospital soaps and gowns just went away when she was discharged last Monday, whereas the rash started a few days ago.

good diagnosis requires lots of questions :).

I had her not take iron or the new fish oil yesterday, and her rash was noticeably better this morning.

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[info]patrissimo
2005-10-18 06:25 am UTC (link)
Oral doses of iron are bound to be a lot higher than IV because you only absorb 22-33% of the iron in supplements (and remember that the supplement is itself listed as ferrous sulfate/gluconate/fumarate which includes the salt in the molecular weight.) So, high doses of oral iron are not as high as they seem.

I didn't know what the absorption rate was, but I did take into account the saltness - the number I gave was elemental iron.

On the other hand, Shannon is probably anemic from blood loss rather than iron loss, so taking a lower dose for a longer period of time may be better. The goal is to supplement iron because she is rebuilding heme cells which require iron. Some of those heme cells can use her stored iron, but eventually she will become depleted of iron if her stores are used up. And yes, Vitamin C will increase absorption of iron.

Right, its blood loss which is the problem, and I figured it takes time to rebuild red blood cells.

As for the rash... is she taking any other medication? If it really is all over her body, she should let the doctor know. There are disease explanations as well as allergic explanations for unexplainable rashes...

It's torso, front and back, not arms/legs. Worse on her upper chest. I asked about all oral medications, others are Motrin (which is unlikely to be problematic), occasional Vicodin (which are again unlikely, she's never shown any signs of opioid allergies), her prenatals (unlikely - she's been taking them for almost a year), stool softener. Hmm, that latter is a possibility too, I forget about it.

It certainly looks like an allergic rash, so disease seems like a pretty unlikely explanation.

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