povidone-iodine and Heart-Arrest

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

We present a case of asystole due to anaphylactoid reaction after vaginal disinfection with povidone iodine under epidural anesthesia combined with general anesthesia. A 71-year-old woman was scheduled to undergo total cystectomy due to vesical cancer, invading into the wall of the vagina. After induction of anesthesia, epidural injection with 10 ml of 1% lidocaine and cleansing the vagina with povidone iodine solution were done at the same time. Shortly thereafter, sudden hypotension and bradycardia and asystole occurred. Multiple doses of epinephrine, chest compression, transcutaneous pacing and defibrillation were required to restore her spontaneous circulation. The surgery was cancelled. She stayed a night at the intensive care unit, and was discharged without any neurological complications the next day. The serum concentration of histamine increased to 7.0 microg x l(-1), but that of tryptase was within normal ranges when spontaneous circulation returned. The serum concentration of total iodine increased to 57.9 microg x dl(-1), which did not reach the toxic level. These results suggest that the circulatory collapse was probably caused by anaphylactoid reaction to povidone iodine. Epidural anesthesia may have worsened the circulatory collapse.

Topics: Aged; Anaphylaxis; Anesthesia, Epidural; Anesthesia, General; Anti-Infective Agents, Local; Cystectomy; Female; Heart Arrest; Humans; Povidone-Iodine; Urinary Bladder Neoplasms

This report describes a case of acute life-threatening iodine toxicity in an infant with Hirschsprung's disease caused by rectal irrigation with povidone-iodine. A hypothesis regarding absorption and recommendations for povidone-iodine usage for bowel preparation are presented.

Topics: Anesthesia, General; Heart Arrest; Hirschsprung Disease; Humans; Infant; Iodine; Male; Povidone-Iodine; Rectum; Therapeutic Irrigation