Document ID: EPA-HQ-OPP-2006-0599-0013
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2009-06-03T04:00Z

INCIDENT REPORTS ASSOCIATED WITH

Iodine and Iodophors

PC CODES: 

046923, 046903, 046904, 046905, 075701, 046901, 046914

December 15, 2008

Genevieve Angle

Jonathan Chen, Ph.D.

U.S. Environmental Protection Agency

Office of Pesticide Programs

Antimicrobials Division

TABLE OF CONTENTS

 TOC \f 

0.0	INTRODUCTION	1

1.0 	INCIDENT REPORT DATA ASSOCIATED WITH THE HEALTH EFFECTS OF IODINE
and IODOPHORS  EXPOSURE	1

1.1 	OPP's Incident Data System (IDS)	2

1.2 	Poison Control Center	2

1.3 	California Data - 1986 through 2006	2

1.4 	National Pesticide Telecommunications Network (NPTN)	4

1.5 	Incident Reports Associated with the Toxic Effects of Iodine and
Iodine Compounds Published in the Scientific Literature.	4

2.0	SUMMARY AND CONCLUSION	10

3.0	REFERENCES	11

 

0.0	INTRODUCTION tc \l1 "0.0 INTRODUCTION 

Iodine, a halogen, is a bluish-black, lustrous solid, and volatizing at
ordinary temperatures into a blue-violet gas with an irritating odor. It
forms compounds with many elements, but is less active than the other
halogens, which displace it from iodides. Iodine exhibits some
metallic-like properties. It dissolves readily in chloroform, carbon
tetrachloride, or carbon disulfide to form beautiful purple solutions.
It is only slightly soluble in water. Iodine compounds are important in
organic chemistry and very useful in medicine.  This report summarizes
the potential health effects of iodine and Iodophors in humans, reported
as incident reports from different sources. Seven active ingredients are
covered in this report:  PC codes 046923 ,046903,  046904, 046905,
075701, 046901, and 046914.

Two approaches are used in this section:

The potential health effects of iodine and iodophors in humans, reported
as incident reports from different sources, are summarized. 

A literature search of chronic health effects associated with iodine and
iodophors exposure, including the results of epidemiological studies, is
summarized.

1.0 	INCIDENT REPORT DATA ASSOCIATED WITH HEALTH EFFECTS OF IODINE AND
IODOPHORS EXPOSURE tc \l1 "1.0 INCIDENT REPORT DATA ASSOCIATED WITH
HEALTH EFFECTS OF IODINE AND IODOPHORS EXPOSURE 

The following databases have been consulted for the poisoning incident
data:

OPP Incident Data System (IDS) - The Incident Data System of The Office
of Pesticide Programs (OPP) of the Environmental Protection Agency (EPA)
contains  reports of incidents from various sources, including
registrants, other federal and state health and environmental agencies
and individual consumers, submitted to OPP since 1992.  Reports
submitted to the Incident Data System represent anecdotal reports or
allegations only, unless otherwise stated.  Typically no conclusions can
be drawn implicating the pesticide as a cause of any of the reported
health effects.  Nevertheless, with enough cases and/or enough
documentation, risk mitigation measures may be suggested.

Poison Control Centers - as the result of a data purchase by EPA, OPP
received Poison Control Center data covering the years 1993 through 1998
for all pesticides.  Most of the national Poison Control Centers (PCCs)
participate in a national data collection system, the Toxic Exposure
Surveillance System, which obtains data from about 65-70 centers at
hospitals and universities.  PCCs provide telephone consultation for
individuals and health care providers on suspected poisonings involving
drugs, household products, pesticides, etc.



California Department of Pesticide Regulation - California has collected
uniform data on suspected pesticide poisonings since 1986.  Physicians
are required, by statute, to report to their local health officer all
occurrences of illness suspected of being related to exposure to
pesticides.  The majority of the incidents involve workers.  Information
on exposure (worker activity), type of illness (systemic, eye, skin,
eye/skin and respiratory), likelihood of a causal relationship, and
number of days off work and in the hospital are provided.

National Pesticide Telecommunications Network (NPTN) - NPTN is a
toll-free information service supported by OPP.  A ranking of the top
200 active ingredients for which telephone calls were received during
calendar years 1984-1991, inclusive, has been prepared.  The total
number of calls was tabulated for the categories of human incidents,
animal incidents, calls for information, and others.

Published Incident Reports - Some incident reports associated with
iodine and iodide related human health hazards are published in the
scientific literature.

1.1 	OPP’s Incident Data System (IDS) tc \l2 "1.1 OPPs Incident Data
System (IDS) 

A total of 8 individual human incident cases submitted to the EPA Office
of Pesticide Programs are associated with exposure to iodine-containing
compounds.  Inhalation and dermal are the two most important routes of
exposure.  The most common symptoms reported for cases of inhalation
exposure were coughing, wheezing, tightness of chest and shortness of
breath. Dermal exposure caused skin burning, blisters and rash.  None of
these effects were considered severe effects.

1.2 	 Poison Control Center tc \l2 "1.2 Poison Control Center 

There are no iodine incidents that have been reported in the American
Association of Poison Control Centers (PCC) Toxic Exposure Surveillance
System (TESS) in the years 1993 - 1998.

1.3 	California Data - 1986 through 2006 tc \l2 "1.3 California Data -
1982 through 2003 

Detailed descriptions of 64 cases with a definite, probable or possible
relationship to iodine-containing compounds have been submitted to the
California Pesticide Illness Surveillance Program (1986-2006).  Table 1
presents the types of illnesses reported by year.  Table 2 gives the
total number of workers that took time off work as a result of their
illness and how many were hospitalized and for how long.

Table 1: Cases Due to Iodine, Iodine-Complex or Potassium Iodide
Exposure in California Reported by Type of Illness and Year, 1986-2006.

Year	Illness Type

	

Systemic	

Gastrointestinal	

Eye	

Skin	

Respiratory	

Combinationa	

Total

1986	

10	

-	

-	

1	

-	

-	

11

1987	

-	

-	

1	

2	

1	

-	

4

1988	

-	

-	

-	

1	

-	

-	

1

1989	

5	

-	

-	

3	

-	

2	

10

1990	

1	

-	

-	

1	

1	

2	

5

1991	

1	

-	

3	

3	

3	

-	

10

1992	

2	

-	

2	

-	

1	

-	

5

1993	

1	

-	

1	

-	

1	

-	

3

1994	

1	

-	

-	

1	

1	

-	

3

1995	

-	

-	

1	

-	

-	

-	

1

1996	

1	

-	

1	

1	

-	

-	

3

1997	

-	

-	

-	

1	

-	

-	

1

1998	

-	

-	

-	

1	

-	

1	

2

1999	

-	

-	

-	

-	

-	

-	

-

2000	

-	

-	

-	

-	

-	

-	

-

2001	

-	

-	

1	

-	

-	

-	

1

2002	

-	

-	

-	

1	

-	

-	

1

2003	-	-	-	-	-	-	-

2004	-	-	1	1	-	-	2

2005	-	-	-	-	-	-	-

2006	-	-	1	-	-	-	1

Total	

22	

-	

12	

17	

8	

5	

64

a Category includes combined irritating effects to eye, skin,
gastrointestinal and respiratory systems.

Table 2: Number of Persons Disabled (taking time off work) or
Hospitalized for Indicated Number of Days After Iodine, Iodine-Complex
or Potassium Iodide Exposure in California, 1986-2006.

	

Number of Persons Disabled	

Number of Persons Hospitalized

One day	

15	

-

Two days	

-	

-

3-5 days	

3	

-

6-10 days	

1	

-

More than 10 days	

-	

-

Unknown	

1	

-

1.4 	National Pesticide Telecommunications Network (NPTN) tc \l2 "1.4
National Pesticide Telecommunications Network (NPTN) 

There are no incidents reported in the NPTN database related to
iodine-containing compounds.

1.5 	Incident Reports Associated with the Toxic Effects of Iodine and
Iodine Compounds Published in the Scientific Literature tc \l2 "1.5
Incident Reports Associated with the Toxic Effects of Iodine and Iodine
Compounds Published in the Scientific Literature 

There are a large number of human incident reports and epidemiological
studies on the effects of excess iodine on human health.  Based on
incidents reported on the toxic effects of pure iodine on humans, an
ingestion of 1 to 8 ounces of iodine can cause death within 48 hours. 
Irrespective to the routes of exposure (oral, dermal) to iodine, gender,
or age, acute irritation effects have been reported in several
incidences. Both high dose exposure and low cumulative doses of iodine
drugs have indicated severe effects in adults and children.  When
pregnant mothers were exposed to iodine containing drugs during
pregnancy, the infants had increased chances of suffering from goiter,
hypothyroidism, cretinism, and several other abnormalities of the
thyroid gland. Transient hypothyroidism may be observed in infants, if
mothers underwent thyroxine treatment for hypothyroidism during
pregnancy; however, infants can recover from transient hypothyroidism
over a period of time.

Table 3: Incident Reports Associated with Oral or Dermal exposure to
Iodine Containing Mixtures

Reference	

Description of Incident	

Dose	

Effects

Finkelstein and Jacobi, 1937	

18 deaths over a period of 6 years from suicides in which adults
ingested iodine 	

1 ounce – 8 ounces of iodine	

death within 48 hours after dosing

Finkelstein and Jacobi, 1937	

A 29-year-old man was admitted to the hospital four days after
attempting suicide by taking tincture of iodine (mixtures of molecular
iodine and sodium triiodide)	

unknown amount of tincture of iodine	

Ulcerations in the mouth increased respiratory rate, vomiting, abdominal
soreness/cramps, urinary retention, twitching, irrationality, fever,
coma, and death.

Clark, 1981	

A man was found dead in his residence with a skull fracture and severe
pneumonia, he was known to be epileptic and a heavy consumer of alcohol;
a 13 oz. rye whiskey bottle was found with him that was 3/4 full of a
brownish liquid that turned out to be iodine	

unclear	

death

Dyck et al., 1979	

A woman was admitted to the hospital after attempting suicide by
ingesting an unknown quantity of Lugol’s iodine (5% diatomic iodine
and 10% potassium iodide)	

Not reported	

Throat burning, esophagitis, gastritis, chemical pulmonary edema,
dyspnea, tachycardia, hyperthyroidism, acute renal failure, metabolic
acidosis.

Vicens-Colvet et al., 1998	

A 28-yr-old asthmatic woman ingested iodine during pregnancy.	

2 to 3 spoonfuls of 130 mg/15 ml of iodide per day. 	

Fetal goiter with hypothyroidism was caused by iodide over dose effect.

Shetty and Duthie, 1990	

A 72-yr-old adult male received providone-iodine skin washes for 6
months to treat dermal ulcers; he had no other history of excess iodine
intake.	

not reported	

hyperthyroidism and thyrotoxicosis

Prager and Gardner, 1979	

A 26-year-old woman had an open fistula which was swabbed 3 days/week
for 22 months with providone-iodine and packed with iodoform impregnated
gauze.	

22 mg I, 3 days/week for 22 months	

Clinical hypothyroidism with thyroid enlargement; became euthyroid
within 6 weeks after the treatment was discontinued.

Okano, 1989	

A 2-year-old girl suffered extensive, patchy erythema on her back,
buttocks and thighs after these areas were in contact with a 10%
providone-iodine solution for 8 hours	

10% providone-iodine solution (exact dose unknown)	

acute irritant contact dermatitis

Tosti et al., 1990	

A 44-yr-old woman suffered from dermatitis for 15 years duration on her
hands and arms, extending to her face, neck, and trunk. Being a masseuse
for 30 years, she had used several many topical medicaments, several
anti-inflammatory drugs, massage creams, and cleansing disinfectants;
thus, exposed to several chemicals.  	

Not reported	

Patch test revealed a strong positive reaction to glutaraldehyde and 10%
povidone-iodine solution.

Tosti et al., 1990	

A 67-yr old woman developed an acute dermatitis with disinfection with
10% povidone-iodine at the skin biopsy site.	

Not reported	

Patch test revealed a strong positive reaction to betadine and 10%
povidone-iodine solution.

Coakley et al., 1989	

A mother took aminophylline and potassium iodide for asthma, during
pregnancy.	

383 mg iodide per 10 ml (during pregnancy). The dose of aminophylline
was not reported.	

The infant became hypothyroid.

Coakley et al., 1989	

A mother took potassium iodide for asthma for sinus medication, during
pregnancy. The mother continued to breast feed the baby while taking the
sinus medication. 	

65 mg iodide per 10 ml (during pregnancy)	

The infant became hypothyroid. The thyroid screen showed abnormality in
the concentration of T4 and TSH. The infant also had a goiter. As soon
as the breast feeding ceased, the thyroid function of the infant
returned to normal. 

Coakley et al., 1989	

There were 12 infants who were applied betadine (10% of povidone-iodine
with 1% of iodine)	

Not reported 	

All developed hypothyroidism. 

Coakley et al., 1989	

A mother received thyroxine treatment for hypothyroidism, presumably
Hashimoto’s thyroditis, at the time of both pregnancies.	

Not reported	

Both the infants had transient hypothyroidism due to maternal
antithyroid antibodies. 

Galina et al., 1962	

A 23 yr old pregnant woman was treated for asthma with potassium iodide
during her pregnancy. On the 44th week of her pregnancy, she delivered a
boy, who died within 18 minutes from birth.	

a total of 324 mg of potassium iodide during pregnancy

	

A large, trilobulated, firm-to-hard mass was palpable over the entire
neck. It was not adhering to the overlying skin, and there were
prominent vessels on the surface of the mass. The infant had a
congenital thyroid goiter.

Galina et al., 1962	A 32-yr old woman took several medicines including
potassium iodide during pregnancy, for bronchial asthma.	Total estimated
intake of potassium iodide during pregnancy was 234 gm.	No effects were
observed in the mother; however, the infant developed a cystic but a
firm mass around the neck. The infant was cyanotic when out of oxygen.
Gradually, the infant developed respiratory distress, and died within 40
hours.

Iancu et al., 1974	

A 31-yr-old woman consumed cough elixir (sodium iodide) for two years,
and even during her pregnancy.	

200 mg I/day 	

hypothyroidism and goiter in infant

Penfold et al., 1978	

During pregnancy a woman had been on multiple drug therapy (salbutamol,
sodium chromoglycate, beclomethasone propionate, and an aminophylline
potassium iodide mixture) for asthma. 	

It was estimated that KI ingested daily during the last trimester was
500 mg.	

Four days after delivery, the infant showed moderate goiter, prominent
tongues, small umbilical hernia, and slight inspiratory stridor. In
addition, absence of epiphyseal centers at the knee and hip was
consistent with intrauterine hypothyroidism. Transfer of trans-placental
iodide was significant in the infant.

Penfold et al., 1978	

A 13-yr old girl suddenly gained weight within two months. Being
asthmatic she had been taking sodium cromoglycate, salbutamol,
beclomethasone propionate, and elixophylline (600 gm of KI/day). 	

elixophylline (600 gm of KI/day)	

Myxoedematous facies, slight obesity, and a moderate diffuse goiter.
After 12 months of discontinuation of KI, she was euthyroid, with slight
palpable goiter.  

Hassan et al., 1968	

During pregnancy a 33-yr-old woman received a treatment with potassium
iodide for chronic asthma. She had been having potassium iodide for 10
years.	

600 mg of Potassium iodide daily.	

The infant (18 days-old) was mildly cyanotic, with marked inspiratory
stridor, tongue enlarged and puffy, infants born with goiter and
hypothyroidism. Skeletal x-ray showed delayed bone age, with absence of
the epiphysial center of lower end of femur, upper end of tibia, and
cuboid bone.  

Hassan et al., 1968	

During pregnancy a 28-yr-old woman received a treatment with potassium
iodide for asthma. 	

Having potassium iodide (1 gm) from the age of 2 up to the time of
delivery.	

The infant appeared cretinoid, pale, with some puffiness of the face, a
large protruded tongue, and some mottling of the skin, goiter and
hypothyroidism.

Hassan et al., 1968	

A 33-yr-old pregnant woman was maintained on bronchodilator for 3 years
from delivery. 	

Daily dose of  0.9 gm of potassium iodide	

The infant born was hypothyroid and had large enlargement of thyroid.

Bostanci et al., 2001	

Mother ingested potassium iodide during her pregnancy.	

170 mg potassium iodide/day starting from the 16th week of gestation.	

Infant born with goiter and hypothyroidism.

Martin and Rento, 1962	

Two years prior to her pregnancy, she received 2 gms of potassium iodide
daily because of increased severity of asthma, and was maintained on it
until delivery.	

2 gm of potassium iodide therapy daily	

Infant born appeared cretinoid and had a conspicuous goiter. The thyroid
was 3 to 4 times the normal size and firm in consistency. After the
first 2 weeks of her life, the baby lost the cretinoid appearance and
the thyroid decreased in size. 

Martin and Rento, 1962	During pregnancy a woman received excessive
iodide therapy (quadrinal, 4 tablets daily) because of chronic asthma.
In addition, in the last trimester, the mother was administered 60 mg of
thyroid extract daily until delivery. 	1200 mg of potassium iodide daily
for three years prior and during pregnancy	The infant born had an
enlarged thyroid, measuring 4 to 9 cm., and firm. The infant had
goitrous cretinism. At 6 months of age the thyroid gland was not
palpable, and the thyroid function studies, and the bone age was normal.

Shilo and Hirsch, 1986	

A 72-year-old woman without apparent preexisting thyroid problems
ingested sea-kelp tablets (4-6 tablets per day); her thyroid status
reverted to normal within 6 months after she stopped taking the tablets	

2.8-4.2 mg I/day 	

hyperthyroidism

Rajatanavin et al., 1984	

A 64-year-old man was given amiodarone (75 mg of iodine per 200 mg
tablet) for intermittent atrial flutter	

75 mg I/day	

angina, fatigue, weight loss, hyperthyroidism, tremor, muscle weakness

Ahmed et al., 1974	

A 15-year-old male received Tedral, Marax, intermittent subcutaneous
epinephrine, SKKI, and organidine for 4 months, for continuous bronchial
asthma. The thyroid gland was diffusely enlarged (estimated 50 g), was
soft, and without a bruit. In addition, there is a family history of
goiter and hyperthyroidism. 	

No specific information on dose was provided.	

hyperthyroidism and thyrotoxicosis

After removal of iodide and iodine containing drugs, the patient’s
thyroid status reverted to normal within 6 months.

Vagenakis et al., 1972	

In a clinical study, eight healthy adult females (age between 34 to 66
yrs) with nontoxic goiter received oral doses of a saturated potassium
iodide solution (5 drops dadily) for 10-18 weeks	

180 mg I/day 	

Four of the eight patients developed hyperthyroidism and thyrotoxicosis.

Shelly, 1967	

A 15-yr old boy was challenged with 10 drops of saturated solution of
potassium iodide orally.	

10 drops of KI administered orally	

Subsequently, high temperature and generalized pruritus. 

Shelly, 1967	A 49-yr woman was challenged with 10 drops of saturated
solution of potassium iodide orally. 	500 mg of iodide on 2 separate
occasions during remission	Several attacks similar to pustular psoriasis
were provoked.

Rosenburg et al., 1972	

A 47-yr-old female received oral doses (3 to 4 tablets per day) of
Quadrinal (is a combination of ephedrine hydrochloride, 25 mg;
theophylline calcium salicylate, 130 mg; phenobarbital, 25 mg; and
potassium iodide, 324 mg) for 1 year as part of asthma treatment.  Other
drugs used in the patient’s treatment were theophylline and
prednisone.	

3 to 4 tablets of Quadrinal daily, and 7.5 mg of theophylline and
prednisone daily.	

Vegetative lesions on the face and arms; healed within 3 weeks after the
potassium iodide was discontinued.

Baumgartner, 1976	

A 75-year-old male suffering from pneumonia was giving a saturated
solution of potassium iodide among other medication	

1,200 mg potassium iodide per day	

skin lesions 

Soria et al., 1990	

 A 50-yr old woman received furosemide, aspirin, potassium iodide
solution, predinisone, and cyclophosphamide for pneumonia.	

520 mg KI/day 	

Lesions of the skin and oral mucosa were observed. Iododerma was
diagnosed, and the medication potassium against iodide-labeled serum
albumin was detected by radioimmunoassay and enzyme linked immunosorbent
assay. The skin lesions healed within 3 weeks of discontinuing potassium
iodide.

Soria et al., 1990	

A 76-yr old adult male received potassium iodide along with theophylline
for obstructive pulmonary disease for 8 months	

160 mg/day of theophylline and potassium iodide was 260 mg/day.

	

Vegetative dermal lesions were observed on the neck and trunk. Iododerma
was suspected, potassium iodide treatment was discontinued. Three weeks
later, only post inflammatory hyperpigmentation and scarring remained. 

Soria et al., 1990

	

A 58-yr old male received potassium iodide along with penicillin for an
acute respiratory tract infection.	

390 mg /day (potassium iodide along with penicillin) 	

After five days of dosing, nodular vegetating lesions with central
ulceration and purulent exudation developed on the scalp, shoulder,
face, and buttocks. A diagnosis of iododerma was suspected, and
potassium iodide was discontinued.

Kincaid et al., 1981	

A 60-yr old woman received three tablets per day of Quadrinal (is a
combination of ephedrine hydrochloride, 25 mg; theophylline calcium
salicylate, 130 mg; Phenobarbital, 25 mg; and potassium iodide, 324 mg)
for 6 months as part of a treatment for chronic obstructive pulmonary
disease.	

740 mg I/day for 6 months	

She developed nodular erythematous skin lesions on her nose, forehead,
and malar areas. Clinically acne rosacea was suspected. A cheek lesion
was excised and was also interpreted as showing chronic inflammation
with psuedoepitheliomatous hyperplasia. In addition, lesions on the
conjunctiva of the eye were observed. The diagnosis of iododerma was
made. 

Khan et al., 1973	

A 65-year-old woman with pneumonia, left ventricular failure and chronic
bronchitis was given potassium iodide daily by mouth	

Treated with 24% oxygen by Venturi Mask, intravenous furosemide, and
digitalis. In addition, parenteral penicillin and potassium iodide, 10
drops (65 mg) 3 times a day via mouth.	

Lesions on skin and hand were erythematous and nodular, with a
fungating, tumor-like appearance, and contained areas of suppuration and
ulceration.

Skin lesions on the face and hands healed completely within 3 weeks
after potassium iodide was discontinued

Pena-Penabad et al., 1993	

A 75-year-old man had suffered from numerous colds that were treated
with potassium iodide and theophylline taken orally.	

not reported	

Outbreaks of papulo-pustulous lesions that formed vegetating masses on
the scalp and arms and conjunctival hemorrhage; lesions disappeared
within one week after treatment with iodine was discontinued.

Kint and Van Herpe, 1976	

A 53 yr-old woman was taking Calcidrine, an expectorant that contains
150 mg calcium iodide per 5 ml syrup, for respiratory infections.	

not specified	

Vegetative hard tumors on face, pre-sternal regions, arms amd lower
legs.

Kint and Van Herpe, 1976	An 82-yr old woman was taking Calcidrine, an
expectorant that contains 150 mg calcium iodide per 5 ml syrup, for
respiratory infections.	not specified	Vegetative skin lesions on face
and fore-arm.

Kurtz and Aber, 1982	

A 73-yr-old male received oral doses of a potassium iodide solution for
15 years	

10 drops of potassium iodide, three times a day for the past 15 years.	

recurrent fevers; fevers stopped within 2 weeks after the potassium
iodide was discontinued

Horn and Kabins, 1972	

A 59-yr-old man was treated for pneumonia with a saturated solution of
potassium iodide, ampicillin sodium and ephedrine sulfate.	

10 drops of potassium iodide for 4 times a day (3 ml KI/day)	

Fever was due to the hypersensitivity of drugs. Also, the man developed
rash.

Horn and Kabins, 1972

	

A 48-yr-old woman received a saturated potassium iodide solution along
with ampicillin to treat pneumonia	

15 drops of potassium iodide for three times a day (3ml KI/day)	

She had fever, and developed rigor, diaphoresis, malaise, and diffuses
myalgia. Fever was temporarily associated with potassium iodide
administration.

Horn and Kabins, 1972	

A 41-yr-old diabetic woman received a saturated potassium iodide
solution along with methicillin sodium, amphicillin sodium, and
aminophylline, hydrocortistirone, for pneumonia.	

10 drops of KI three times a day (2 ml/day)	

Fever, chills, and leukocytosis were temporarily treated to ingestion of
potassium iodide was discontinued.

Tresch et al., 1974	

A 54-yr-old male inadvertently drank a potassium iodide solution.	

600 ml of potassium iodide solution with 15 grams of iodide	

Cardiac irritability; ventricular tachycardia; swelling of the face,
neck and mouth; edema; conjunctivitis; enlarged salivary glands.

Garijo et al., 1996	

A 37-yr old man underwent an intraarticular administration of
mepivacaine hydrochloride and paramethasone acetate in his right knee. 

	

Not reported	

With the history of allergic rhinitis, the 37-yr old man presented
urticaria, dyspnea, wheezing, rhinorrhea, and dysphonia. Only povidone
present within paramethasone was responsible for severe anaphylactic
responses in the patient. 



2.0 Summary and Conclusion

Iodine is a naturally occurring element that is essential for the good
health of people and animals. Iodine is found in small amounts in sea
water and in certain rocks and sediments. Iodine occurs in many
different forms. Most forms of iodine easily dissolve in water or
alcohol. Iodine has many uses. Its most important use is as a
disinfectant. Incidents of death due to iodine exposure have been
reported but only happened at high doses.  Irritation effects were
reported when exposure to iodine compounds occurred through any route of
exposure (oral, dermal or inhalation). Goitrogenic effects were noticed
in several incidences.

3.0 References

Ahmed M, Doe RP, Nuttall FQ.  1974.  Triiodothyronine thyrotoxicosis
following iodide ingestion: A case report.  J Clin Endocrinol Metab 38:
574-576.

Baumgartner TG.  1976.  Potassium iodide and iododerma.  Am J Hosp Pharm
33: 601-603.

Bostanci I, Sarioglu A, Ergin H, et al.  2001.  Neonatal goiter caused
by expectorant usage. Journal of Pediatric Endocrinology & Metabolism
14(8): 1161-1162.

Clark MN.  1981.  A fatal case of iodine poisoning.  Clin Toxicol 18(7):
807-811.

Coakley JC, Francis I, Gold H, et al. 1989.  Transient primary
hypothyroidism in the newborn: Experience of the Victorian Neonatal
Thyroid Screening Programme.  Aust Paediatr J 25: 25-30.

Dyck RF, Bear RA, Goldstein MB, et al.  1979.  Iodine/iodide toxic
reaction: Case report with emphasis on the nature of the metabolic
acidosis.  Can Med Assoc J 120: 704-706.

Finkelstein R, Jacobi M.  1937.  Fatal iodine poisening: A
clinico-pathologic and experimental study.  Adv Intern Med 60:
1283-1296.

Galina MP, Avnet NL, Einhorn A.  1962.  Iodides during pregnancy: An
apparent cause of neonatal death.  N Engl J Med 267: 1124-1127.

Hassan AI, Aref GH, Kassem AS.  1968.  Congenital iodide-induced goitre
with hypothyroidism.  Arch Dis Child 43: 702-704.

Horn B, Kabins SA.  1972.  Iodide fever.  Am J Med Sci 264(6): 467-471.

Khan F, Einbinder JM, Seriff NS.  1973.  Suppurative ulcerating
iododerma-a rare manifestation of inorganic iodide hypersensitivity.  N
Engl J Med 289: 1018-1020.

Kincaid MC, Green WR, Hoover RE, et al.  1981.  Iododerma of the
conjunctiva and skin. Ophthalmology 88: 1216-1220.

Kint A, Van Herpe L.  1977.  Iododerma.  Dermatologica 155(3): 171-173.

Kurtz SC, Aber RC.  1982.  Potassium iodide as a cause of prolonged
fever.  Arch Intern Med 142: 1543-1544.

Iancu T, Boyanower Y, Laurian N.  1974.  Congenital goiter due to
maternal ingestion of iodide.  Am J Dis Child 128: 528-530.

Martin MM, Rento RD.  1962.  Iodide goiter with hypothyroidism in 2
newborn infants. J Pediatr 61: 94-99.

Okano M. 1989.  Irritant contact dermatitis caused by the
providone-iodine.  J Am Acad Dermatol 20(5): 860.

Pena-Penabad C, De Unamuno P, Garcis-Silva J, et al.  1993.  Vegetating
iododerman and conjunctival involvement.  EJD Eur J Dermatol 3: 671-673.

Penfold, JL, Pearson CC, Savage JP, et al.  1978.  Iodide induced goitre
and hypothyroidism in infancy and childhood.  Aust Paediatr J 14: 69-73.

Prager EM, Gardner RE.  1979.  Iatrogenic hypothyroidism from topical
iodine-containing medications.  West J Med 130(6): 553-555.

Rajatanavin R, Safran M, Stoller WA, et al.  1984.  Five patients with
iodine-induced hyperthyroidism.  Am J Med 77: 378-384.

Rosenberg FR, Einbinder J, Walzer RA, et al.  1972.  Vegetating
iododerma.  Arch Dermatol 105: 900-905.

Shelly WB. 1967.  Generalized pustular psoriasis induced by potassium
iodide.  JAMA 201(13): 133-138.

Shetty KR, Duthie EH.  1990.  Thyrotoxicosis induced by topical iodine
application.  Arch Intern Med 150: 2400-2401.

Shilo S, Hirsch HJ.  1986.  Iodine-induced hyperthyroidism in a patient
with a normal thyroid gland.  Postgrad Med J 62: 661-662.

Soria C, Allegue F, Espana A, et al.  1990.  Vegetating iododerma with
underlying systemic diseases: Report of three cases.  J Am Acad Dermatol
22:418-422.

Tresch DD, Sweet DL, Keelan MHJ, et al.  1974.  Acute iodide
intoxication with cardiac irritability.  Arch Intern Med 134: 760-762.

Vagenakis AG, Wang C-A, Burger A, et al.  1972.  Iodide-induced
thyrotoxicosis in Boston.  N Engl J Med 287(11): 523-527.

Vicens-Calvet E, Potau N, Carreras E, et al.  1998.  Diagnosis and
treatment in utero of goiter with hypothyroidism caused by iodide
overload.  J Pediatr 133: 147-148.

  

 PAGE   

 PAGE   1