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Fatal iatrogenic iodine toxicity in a nine-week old infant
T L Kurt1, M L Morgan, V Hnilica
1North Texas Poison Center, Parkland Memorial Hospital, Dallas, TX 75235, USA.
Insights
Excessive internal use of povidone-iodine (PVP-I) can be fatal. This case report details a fatal outcome in an infant due to povidone-iodine toxicity from improper administration.
Area of Science:
- Toxicology
- Pediatric Medicine
- Gastroenterology
Background:
- Povidone-iodine (PVP-I) is a widely used topical antiseptic since the 1950s.
- Its internal use is not standard practice and carries significant risks.
Observation:
- A 9-week-old infant received multiple doses of povidone-iodine via nasogastric tube for colic.
- The infant was found deceased three hours after the final dose.
Findings:
- Autopsy revealed intestinal corrosion and necrosis.
- Extremely elevated blood iodine levels (total, protein-bound, and inorganic) were detected.
Implications:
- This case highlights the severe toxicity and potential lethality of excessive internal povidone-iodine administration.
- Emphasizes the critical importance of adhering to proper administration guidelines for all medical agents, especially in pediatric patients.
Background:
Povidone-iodine has been used since the 1950s for various labelled uses as a topical antiseptic. The toxicity of an excessive dose in internal use is described in this case report.
Case Report:
A 9-week old infant was treated for colic by a pediatric gastroenterologist with loperamide and the elimination of nonhuman milk. Without improvement he was hospitalized and given an enema of 50 mL of povidone-iodine diluted in 250 mL of a bowel irrigant. The enema was promptly expelled and 50 mL of the described solution was given hourly for three doses by nasogastric tube. The infant was found lifeless three hours after the last dose and resuscitation was unsuccessful. Autopsy showed a corroded and necrotic intestinal tract, serous fluid in body cavities, a blood total iodine of 14,600 micrograms/dL, protein-bound iodine of 3,400 micrograms/dL and inorganic iodine of 11,700 micrograms/dL.