povidone-iodine and Acidosis

A critical elevation of povidone-iodine absorption which occurred in a burn patient who was topically treated with 10% povidone-iodine (PI) gel is herein reported. A 65-year-old man was admitted to our hospital for deep second- and third-degree burns covering 26% of his total body surface area. The intravenous administration with lactated Ringer's solution and topical treatment with silver sulfadiazine were applied in addition to such treatments as debridement and skin grafting. However, wound infection occurred due to Pseudomonas aeruginosa. Topical treatment with PI gel was effective for this condition. Persistent nodal bradycardia with hypotension, metabolic acidosis, and renal failure occurred 16 days after the start of PI gel treatment. Iodine toxicosis caused by PI gel was suspected with a serum iodine level of 20600 microg/dl (normal range 2-9 microg/dl). The PI gel treatment was therefore discontinued immediately, and hemodialysis was scheduled. However, the patient's family refused hemodialysis and he died 44 days after admission. To our knowledge, only eight patients with iodine toxicosis have been reported in burn patients treated with PI gel.

Topics: Absorption; Acidosis; Aged; Anti-Infective Agents, Local; Bradycardia; Burns; Debridement; Fatal Outcome; Gels; Humans; Hypotension; Iodine; Male; Povidone-Iodine; Pseudomonas Infections; Renal Insufficiency; Silver Sulfadiazine; Skin Transplantation; Wound Infection

Although peritoneal lavage with povidone-iodine (PVPI) is frequently performed after surgery on the gastrointestinal tract, the effects of PVPI on the intestinal epithelial barrier are unknown. The purpose of this study was to investigate the effects of abdominal irrigation with PVPI on the intestinal epithelial barrier in a colorectal cancer (CRC)-induced rat model.. The CRC model was induced in rats with azoxymethane and dextran sodium sulfate. Next, a total of 24 male CRC-induced rats were randomly divided into three groups (n = 8): (1) a sham-operated group, (2) an NS group (peritoneal lavage 0.9% NaCl), and (3) a PVPI group (peritoneal lavage with 0.45%-0.55% PVPI). The mean arterial pressure was continuously monitored throughout the experiment. The levels of plasma endotoxin and D-lactate, blood gases, and protein concentration were measured. The ultrastructural changes of the epithelial tight junctions were observed by transmission electron microscopy.. The mean arterial pressure after peritoneal lavage was lower in the PVPI group than that in the NS group. The protein concentration and levels of endotoxin and D-lactate were higher in the PVPI group than they were in the PVPI group. In addition, PVPI treatment resulted in a markedly severe metabolic acidosis and intestinal mucosal injury compared with NS rats.. Peritoneal lavage with PVPI dramatically compromises the integrity of the intestinal mucosa barrier and causes endotoxin shock in CRC rats. It is unsafe for clinical applications to include peritoneal lavage with PVPI in colorectal operations.

Topics: Acidosis; Animals; Anti-Infective Agents, Local; Azoxymethane; Bacterial Translocation; Colorectal Neoplasms; Dextran Sulfate; Endotoxins; Gastrointestinal Microbiome; Humans; Intestinal Mucosa; Male; Microscopy, Electron, Transmission; Neoplasms, Experimental; Peritoneal Absorption; Peritoneal Lavage; Permeability; Povidone-Iodine; Rats; Rats, Sprague-Dawley; Shock, Septic; Tight Junctions

We present a case study of a severe episode of iodine toxicity following povidone-iodine wash with clinical manifestations of cardiovascular collapse, metabolic acidosis, renal failure and seizures. Povidone-iodine has been used as a medical antiseptic and disinfectant since 1952 Iodine toxicity secondary to povidone-iodine use is rare. Iodine toxicity is difficult to diagnose and the diagnosis is made by a high index of suspicion. Toxicity due to iodine correlates with serum and urine iodine levels. Treatment of iodine toxicity is supportive. A review of literature relating to the components of povidone-iodine, iodine metabolism, its manifestations and management of iodine toxicity secondary to povidone-iodine is also presented. An Ovid-Medline search from 1950 to 2009 revealed 1236 articles on the clinical manifestations of povidone-iodine usage but no article on iodine toxicity relating to povidone-iodine based on the following search criteria: povidone-iodine and/or iodine toxicity secondary to povidone-iodine (limited to English language, review articles, full text and human patients).

Topics: Acidosis; Aged; Anti-Infective Agents, Local; Anticonvulsants; Diuretics; Fluid Therapy; Follow-Up Studies; Furosemide; Heart Arrest; Hemodiafiltration; Humans; Iodine; Male; Povidone-Iodine; Renal Insufficiency; Seizures; Therapeutic Irrigation

Topics: Acidosis; Humans; Iodine; Povidone-Iodine; Solutions; Therapeutic Irrigation

Topics: Acidosis; Administration, Topical; Burns; Humans; Hydrogen-Ion Concentration; Povidone; Povidone-Iodine

Two experimental studies were carried out upon dogs to clarify the efficacy of peritoneal povidone-iodine lavage in peritonitis. With an experimental model of peritonitis which closely resembles the clinical situation, we found that peritoneal lavage with povidone-iodine was not more effective than other lavage regimens in decreasing bacterial colony counts and was associated with an early 100 per cent mortality. Renal function was not affected by the treatment with this antiseptic solution. However, we found a statistically significant superimposed metabolic acidosis in the peritonitis group treated with povidone-iodine when compared with the other groups, by means of a significant decrease in base excess, p less than 0.01, at the two hour postlavage measures. This metabolic acidosis was also observed in normal dogs undergoing peritoneal lavage with povidone-iodine, showing a significant decrease in serum bicarbonate level one hour, p less than 0.05, and three hours, p less than 0.01, three hours postlavage, when compared with a sham laparotomy group in the nonperitonitis study. This has not previously been experimentally investigated. In view of these results, we do not recommend the clinical use of povidone-iodine solution for peritoneal lavage in peritonitis.

Topics: Acidosis; Animals; Bicarbonates; Disease Models, Animal; Dogs; Female; Humans; Ileum; Ligation; Peritonitis; Povidone; Povidone-Iodine; Prognosis; Solutions; Therapeutic Irrigation

Topics: Acidosis; Administration, Topical; Adult; Burns; Female; Humans; Hypernatremia; Povidone; Povidone-Iodine

One of the dangers of topical therapy in thermal injuries is absorption of the therapeutic agent with subsequent metabolic and toxic complications. Two patients, one 30 years old with a 75% burn, the second 72 years old with a 35% burn, were treated topically with povidone-iodine ("Betadine", pH 2.43). In both patients severe metabolic acidosis developed which could not be attributed to sepsis, hypovolaemia, renal failure, diabetes, lactic acidaemia, &c. The acidosis associated with the 75% burn required large amounts of sodium bicarbonate to maintain pH at 7.35 and a serum-bicarbonate concentration of 15 mmol/l (meq/l); serum-iodine was 48000 mug/dl (normal 4-8.5mug/dl). Acidosis in the second patient was not as severe, and serum-iodine concentration reached 17600 mug/dl. The rate of urinary excretion of iodine was 50.8 +/- 7.4 mg/dl and seemed to be fixed. Haemodialysis was very effective in reducing serum-iodine concentration. Povidone was also systemically absorbed. The persistent acidosis could be caused by absorption of the iodine or the acidic povidone-iodine. Until the aetiology of the acidosis and renal damage is more clear, iodophors should not be used topically for burns greater than 20% of the body surface or in the presence of renal failure.

Topics: Absorption; Acid-Base Imbalance; Acidosis; Administration, Topical; Adult; Aged; Bicarbonates; Burns; Creatinine; Female; Humans; Iodine; Kidney; Male; Povidone; Povidone-Iodine; Renal Dialysis; Sodium

Topics: Acidosis; Burns; Humans; Povidone; Povidone-Iodine

Providone-iodine is used as a topical antimicrobial in burn patients. Although absorption of iodine has been thought to be negligible, several patients have recently been noted with substantial elevations of serum free iodide. Unexplained abnormalities occurred in several of these patients, renal failure, metabolic acidosis, and elevation of serum glutamic oxaloacetic transaminase. It is conceivable that the large iodide loads noted were at least in part responsible for these abnormalities.

Topics: Acid-Base Equilibrium; Acidosis; Administration, Topical; Adolescent; Adult; Aspartate Aminotransferases; Burns; Carbon Dioxide; Female; Humans; Hydrogen-Ion Concentration; Infant; Iodides; Iodine; Kidney; Male; Middle Aged; Peritoneal Dialysis; Povidone; Povidone-Iodine; Time Factors