title: Complications of povidone-iodine absorption in topically treated burn patients.
abstract: 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.
mesh_terms: D000042:Absorption; D000137:Acid-Base Imbalance / Q000503:physiopathology; D000138:Acidosis / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood / Q000627:therapeutic use; D002056:Burns / Q000188:drug therapy*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007455:Iodine / Q000097:blood; D007668:Kidney / Q000503:physiopathology; D008297:Male; D011205:Povidone / Q000031:analogs & derivatives*; D011206:Povidone-Iodine / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D006435:Renal Dialysis; D012964:Sodium / Q000627:therapeutic use
chemical_list: D001639:Bicarbonates; D011206:Povidone-Iodine; D007455:Iodine; D012964:Sodium; D003404:Creatinine; D011205:Povidone