Induction of a critical elevation of povidone-iodine absorption in the treatment of a burn patient: report of a case.
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.
Department of Surgery, Fujiyoshida City Hospital, Yamanashi, Japan.
M
M
Aiba
J
J
Ninomiya
K
K
Furuya
H
H
Arai
H
H
Ishikawa
S
S
Asaumi
A
A
Takagi
S
S
Ohwada
Y
Y
Morishita
D000042:Absorption; D000138:Acidosis / Q000139:chemically induced*; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000009:adverse effects* / Q000627:therapeutic use; D001919:Bradycardia / Q000139:chemically induced*; D002056:Burns / Q000382:microbiology / Q000628:therapy*; D003646:Debridement; D017809:Fatal Outcome; D005782:Gels; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D007455:Iodine / Q000097:blood; D008297:Male; D011206:Povidone-Iodine / Q000009:adverse effects* / Q000627:therapeutic use; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology; D051437:Renal Insufficiency / Q000139:chemically induced*; D012837:Silver Sulfadiazine / Q000627:therapeutic use; D016038:Skin Transplantation; D014946:Wound Infection / Q000188:drug therapy / Q000382:microbiology
D000891:Anti-Infective Agents, Local; D005782:Gels; D011206:Povidone-Iodine; D007455:Iodine; D012837:Silver Sulfadiazine