Anemia, meat, and iron supplement

	Asked by Unregistered (Female; 91; USA; High blood pressure, low back pain, Stage 4 hemorrhoid (Hemorrhoid surgery in 1989). Clogged artery in the neck?? Heart attack once many many years ago.; Relevant drugs:Norvasc 5 mg twice daily, Diovan 80 mg twice daily, Aspirin 81 mg once daily, iron supplement, glucosamine and chondrointin. ) on Thu 18, Sep 2008 09:05pm :
	My mom is 91 yrs old. She has stage 4 hemorrhoid that causes daily bleeding. She try to eat a lot of meat and takes 4 iron pills a day. Each pill is 160 mg. Ferrous Sulfate (50 mg. Elemental iron). Her blood tests results are: Red blood count = 3.39 (normal=3.8-5.1) Hemoglobin = 9.6 (normal=11.7-15.5) Hematocrit = 29 (normal = 35-45) Total iron = 17 (normal = 40-160) TIBC = 324 (normal = 250-450) % Transferrin Saturation = 5 (15-50) Ferritin = 21 (normal = 20-288) BUN = 22 (normal = 7-25) Creatinine = 1.29 (normal=0.5-1.2) eGFR = 39 (normal >=60) 1. What is the maximum dose of iron that she can take before it becomes toxic? 2. Her estimated Glomerular Filtration Rate (eGFR=39) is low, last year's eGFR=45. Can eating too much meat cause a problem with her kidney? Does she have a kidney problem? Thank you in advance for your help.
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	Answer by Dr Bhupinder K, MD (doctor) on Fri 19, Sep 2008 11:22am: Hi, Ingestions of less than 20 mg./kg. of elemental iron are considered non-toxic, ingestions of 20-60 mg./kg. produce mild to moderate toxicity, and ingestions of greater than 60 mg./kg. of elemental iron have the potential to produce serious toxicity. Hence, even upto 10 tablets/ day shouldn’t lead to a serious toxicity, however, excessive consumption beyond the routine therapeutic dose can result in adverse effects. It always makes sense to treat the primary pathology (hemorrhoids), if possible. She definitely has got a mild to moderate renal dysfunction and it’s always good to avoid too much proteins in the diet as they put excessive load on the kidneys in the form of urea and other nitrogenous waste products and hence she should avoid excessive meat consumption. Simultaneously, it’s very important to keep her blood pressure in control as hypertension (high blood pressure) is one of the important triggers of deteriorating kidney function. Hope that helps. Warm Regards.
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