Iodine

Direct observations: clinical cases, poisoning incidents and other

Administrative data

Endpoint:

direct observations: clinical cases, poisoning incidents and other

Type of information:

other: poisoning incidents

Adequacy of study:

supporting study

Reliability:

4 (not assignable)

Data source

Reference

Reference Type:

publication

Title:

Acute hemolysis following iodine tincture ingestion.

Author:

Mao YC, Tsai WJ, Wu ML, Ger J, Deng JF, Yang CC.

Year:

2011

Bibliographic source:

Hum Exp Toxicol. 2011 Oct;30(10):1716-9.

Materials and methods

Study type:

poisoning incident

Endpoint addressed:

acute toxicity: oral

Test guideline

Qualifier:

no guideline followed

Principles of method if other than guideline:

It reported an unusual case of severe hemolysis and acute renal failure following intentional ingestion of iodine tincture containing 60 mg/mL iodine and 40 mg/mL potassium iodide in 70% v/v ethanol.

GLP compliance:

not specified

Test material

Test material information

Constituent 1

Reference substance name:

Iodine

EC Number:

231-442-4

EC Name:

Iodine

Cas Number:

7553-56-2

Molecular formula:

I2

IUPAC Name:

iodine

Constituent 2

Reference substance name:

Potassium iodide

EC Number:

231-659-4

EC Name:

Potassium iodide

Cas Number:

7681-11-0

Molecular formula:

IK

IUPAC Name:

potassium iodide

Details on test material:

Iodine tincture containing 60 mg/ml iodine and 40 mg/ml potassium iodide in 70% v/v ethanol.

Method

Type of population:

general

Subjects:

- Number of subjects exposed: 1
- Sex: male
- Age: 30
- Known diseases: previously healthy

Route of exposure:

oral

Reason of exposure:

intentional

Exposure assessment:

not specified

Details on exposure:

A 30-year-old previously healthy male attempted suicide by ingesting 200 ml ‘‘iodine tincture’’ stored as an antiseptic in his house because of socioeconomic stress.

Medical treatment:

Three sessions of plasma exchange (PE) with the dose of 2600 mL over 2 hours per day was arranged for suspected iodine-related severe intravascular hemolysis. Moreover, intermittent hemodialysis (HD) was required because of persistent anuria after day 3. Eighty hours post-ingestion, tarry stool with Hb decreasing to 7.4 g/dL was noted. Upper gastrointestinal (GI) endoscopy was not performed because he could not tolerate the procedure. He received conservative treatments only for probable corrosive injury of GI tract.

Results and discussion

Clinical signs:

He soon developed sore throat, epigastralgia as well as bilateral flank pain. However, he did not seek medical help until 12 hours later. He was referred to our service 18 hours post-ingestion due to acute renal failure.

Results of examinations:

On arrival, his vital signs were blood pressure 148/98 mmHg, pulse rate 91/min, respiratory rate 20/min, temperature 37.6°C. Physical examinations revealed slight icteric sclera while no cyanosis presented. His chest X-ray and electrocardiogram were within normal limits. Laboratory data were remarkable for white blood cell count 35,200 E+09/L with 91% neutrophils, hemoglobin (Hb) 14 g/dL; serum C-reactive protein 2.09 mg/dL, potassium 5.6 mEq/L, blood urea nitrogen 46 mg/dL, creatinine 3.76 mg/ dL, aspartate aminotransferase 545 U/L, alanine aminotransferase 51 U/L, lactate dehydrogenase 5,563 U/L, total bilirubin 2.45 mg/dL with conjugated form of 0.56 mg/dL, and plasma free Hb of 222 mg/dL (reference range 1-5 mg/dL). Arterial blood gases under 3 L/min O2 supplement revealed pH 7.35, PaCO2 33.8 mm Hg, PaO2 71.5 mm Hg and HCO3- 18.1 mEq/L. Toxicological screening for basic drugs and paraquat were negative.

Effectivity of medical treatment:

His hospital course was further complicated with aspiration pneumonia and respiratory failure that occurred 2 weeks post-ingestion, which necessitated 3 weeks of mechanical ventilation. His renal function gradually recovered 5 weeks later, and he was discharged 8 weeks post-ingestion.
Total serum iodine level excluding protein-bound iodine at our emergency department was found to be 1,155,901 μg/L (reference range 30.48-80.01 μg/L), measured by inductively coupled plasma mass spectrometry, a method described elsewhere.7 The level then decreased steeply and was 63,336 μg/L and 4,849 μg/L on day 6 and day 11, respectively.

Applicant's summary and conclusion

Conclusions:

The effects of iodine species exert on tissues are quite complex. In addition to direct kidney injury, exposure to large dose iodine tincture may lead to severe hemolysis through complex and not well-understood mechanisms. It is speculated that oxidative stress play one of the important roles. Plasma exchange may be effective in the management of iodine poisoning.

Executive summary:

It reported an unusual case of severe hemolysis and acute renal failure following intentional ingestion of iodine tincture containing 60 mg/mL iodine and 40 mg/mL potassium iodide in 70% v/v ethanol. The patient completely recovered 8 weeks later after receiving supportive treatment, plasma exchange, and temporary hemodialysis.