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Iodine Poisoning

IODISM

Iodine poisoning or iodine excess is an increased level of iodine in the tissues leading to complications. It may be endemic in regions where the diet consists of food with abundant iodine or it is seen in cases related to acute iodine exposure e.g. during the administration of iodine in high doses required for radiologic diagnostic procedures.


Presentation

Iodine poisoning is reported in several countries and the number of cases is constantly increasing [1] [2]. Complications associated with this type of poisoning are linked to the thyroid gland, such as hypothyroidism, malignancy, hyperthyroidism, and autoimmune thyroid disease [3]. Research suggests these disorders are related to reactive oxygen species (ROS) causing oxidative stress, as well as consequent recruitment of immune cells and release of cytokines [4].

Patients might get an excess of this mineral by including iodinated salt in their diet or by taking dietary supplements containing iodine. Also, contrast agents used e.g. in coronary angiography or other radiologic procedures contain iodine that elevates its amount in the tissues, particularly in the thyroid gland. Some cases describe patient death caused by cardiac arrest after investigations with contrast agents. Additionally, treatment of Graves disease includes administration of iodine-containing agents that lower production of the thyroid hormones but increase iodine concentration, leading to possible toxicity [5].

The medical staff is at risk of iodine excess from the use of antiseptics that include iodine e.g. povidone-iodine, as it is absorbed through the skin [5].

Radioactive iodine (131I) produced by the fission of uranium is also the cause of major complications. A study suggested that children located in a 300-mile radius from Chernobyl nuclear accident were affected and developed malignant tumors of the thyroid gland [6].

Furthermore, medications such as amiodarone (used to treat ventricular and supraventricular arrhythmias) have iodine incorporated within their active substance, and contain up to about 37% of the iodine in a dose. Amiodarone induces hypothyroidism or, more frequently, thyrotoxicosis called amiodarone-induced thyrotoxicosis (AIT). AIT is further classified into two types:

  1. type AIT is characterized by increased production of thyroid hormones;
  2. type AIT is linked with destructive thyroiditis [7].
Fever
  • Abdominal pain Coma Delirium Fever Lack of urine output Seizure Shock Shortness of breath Stupor Swelling of face and body Weak pulse Side Effects of Iodine Poisoning A patient with an overdose of iodine shows symptoms that are similar to iodine deficiency[tandurust.com]
  • Poisoning may also cause coughing, fever, thirst, and stomach pain. Although these symptoms are generally considered common, they may still be dangerous if they occur with other, more potentially fatal conditions.[wisegeek.com]
  • Furthermore, there may be fever while some develop delirium. It is frequent for a casualty to report pain in the throat and mouth and metallic taste in the mouth.[ic.steadyhealth.com]
  • Symptoms Abdominal pain Coughing Delirium Diarrhea Fever Metallic taste in mouth Mouth and throat pain No urine output Seizures Shock Shortness of breath Stupor Thirst Vomiting Home Treatment Seek immediate medical help.[indiatoday.intoday.in]
  • The signs and symptoms of Iodine Poisoning may include Fever Metallic taste in the mouth Burning sensation and pain in mouth and throat Appetite loss Drooling from the mouth; increased thirst Nausea and vomiting Diarrhea (blood in stool, in some cases[dovemed.com]
Diarrhea
  • Symptoms include burning pain in the mouth and esophagus, abdominal pain, vomiting, diarrhea, delirium, shock, nephritis, laryngeal edema, and circulatory collapse.[medical-dictionary.thefreedictionary.com]
  • Six hours later she became acutely ill with vomiting, diarrhea, faintness, pain in the hands, fingers, wrists, and face, followed almost immediately by urticarial wheals over the knuckles, wrists, forearms, forehead, nose, lips, chin, cheeks, ears, and[annals.org]
  • Signs of Iodine Toxicity Harmless amount of iodine contained in medicine results in these initial symptoms: Burning mouth and throat Head cold symptoms Skin rash Sore throat and gums Stomach upset Diarrhea Vomiting Toxicity from iodine is a risk as it[tandurust.com]
  • In more severe instances of poisoning, uncontrollable vomiting and diarrhea may occur. Poisoning may also cause coughing, fever, thirst, and stomach pain.[wisegeek.com]
  • Iodine Poisoning Symptoms and Signs In majority of iodine poisoning cases people start to cough and experience abdominal pain and diarrhea. Furthermore, there may be fever while some develop delirium.[ic.steadyhealth.com]
Vomiting
  • This condition is marked by brown stains on the lips and mouth; burning pain in the mouth, throat, and stomach; vomiting (blue vomit if the stomach contained starches, otherwise yellow vomit); bloody diarrhea.[medical-dictionary.thefreedictionary.com]
  • There is vomiting, food masses are colored dark yellow or blue (if there is starchy food in the stomach) color. Possible blood impurities. Diarrhea, sometimes with blood.[en.intoxication-stop.com]
  • Apply this treatment only when the victim is alert but discontinue treatment when victim is vomiting or having convulsions. Activated charcoal is effective in decontaminating the stomach.[tandurust.com]
  • In more severe instances of poisoning, uncontrollable vomiting and diarrhea may occur. Poisoning may also cause coughing, fever, thirst, and stomach pain.[wisegeek.com]
  • DO NOT give these items if the patient is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.[indiatoday.intoday.in]
Abdominal Pain
  • Abdominal pain Coma Delirium Fever Lack of urine output Seizure Shock Shortness of breath Stupor Swelling of face and body Weak pulse Side Effects of Iodine Poisoning A patient with an overdose of iodine shows symptoms that are similar to iodine deficiency[tandurust.com]
  • Iodine Poisoning Symptoms and Signs In majority of iodine poisoning cases people start to cough and experience abdominal pain and diarrhea. Furthermore, there may be fever while some develop delirium.[ic.steadyhealth.com]
  • Symptoms include burning pain in the mouth and esophagus, abdominal pain, vomiting, diarrhea, delirium, shock, nephritis, laryngeal edema, and circulatory collapse.[medical-dictionary.thefreedictionary.com]
  • Symptoms Abdominal pain Coughing Delirium Diarrhea Fever Metallic taste in mouth Mouth and throat pain No urine output Seizures Shock Shortness of breath Stupor Thirst Vomiting Home Treatment Seek immediate medical help.[indiatoday.intoday.in]
  • pain; irritation of the stomach Skin lesions that resemble acne Mouth ulcers Bluish discoloration of skin on lips and beneath fingernails Breathing difficulties; coughing Breathing-in iodine vapors may result in lung irritation and edema (fluid in the[dovemed.com]
Nausea
  • At the beginning stages, a person may experience nausea. In more severe instances of poisoning, uncontrollable vomiting and diarrhea may occur. Poisoning may also cause coughing, fever, thirst, and stomach pain.[wisegeek.com]
  • The signs and symptoms of Iodine Poisoning may include Fever Metallic taste in the mouth Burning sensation and pain in mouth and throat Appetite loss Drooling from the mouth; increased thirst Nausea and vomiting Diarrhea (blood in stool, in some cases[dovemed.com]
  • Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Less common Diarrhea nausea or vomiting stomach pain Other side effects not listed may also occur in some[mayoclinic.org]
  • Acute iodine toxicity may cause symptoms such as diarrhea, nausea and vomiting, as well as a burning sensation in the stomach, throat and mouth. Weak pulse and coma are also potential complications of acute toxicity.[livestrong.com]
  • Vomiting Nausea Diarrhea Burning sensations, occurring on the tongue, in the throat, or in the stomach Abdominal cramps Weak pulse Fainting Coma Elevated iodine consumption over time can sometimes affect the thyroid , causing either hypothyroidism or[vitamins.lovetoknow.com]
Abdominal Cramps
  • Vomiting Nausea Diarrhea Burning sensations, occurring on the tongue, in the throat, or in the stomach Abdominal cramps Weak pulse Fainting Coma Elevated iodine consumption over time can sometimes affect the thyroid , causing either hypothyroidism or[vitamins.lovetoknow.com]
Confusion
  • Check with your doctor as soon as possible if any of the following side effects occur: Less common Hives joint pain swelling of the arms, face, legs, lips, tongue, and/or throat swelling of the lymph glands With long-term use Burning of mouth or throat confusion[mayoclinic.org]
  • Initial Symptoms Initial symptoms of iodine toxicity may be: Skin rash Burning mouth and throat Sore teeth and gums Head cold symptoms Vomiting Stomach upset and diarrhea These symptoms may be confused with an iodine allergy or iodine allergy symptoms[iodine-resource.com]
  • […] noticed in both adults and children include: Abdominal pain which can vary from mild to moderate Metallic taste can be felt in the mouth, quite frequently Pain in throat and mouth Low or no urine output Shortness of breath Shock and seizures Mental confusion[buzzle.com]
  • People often get confused with the Iodine Deficiency and Overdose. Both has a drastic effect on the body but the course of action for both the problems are entirely different. So, it is important to understand the symptoms of the iodine overdose.[overdoseinfo.com]
  • There’s a lot of confusion about what’s going on , not surprisingly. It does seem like authorities are handing out iodide tablets as a precaution against radiation poisoning, however.[ljkboerner.wordpress.com]
Stupor
  • Abdominal pain Coma Delirium Fever Lack of urine output Seizure Shock Shortness of breath Stupor Swelling of face and body Weak pulse Side Effects of Iodine Poisoning A patient with an overdose of iodine shows symptoms that are similar to iodine deficiency[tandurust.com]
  • More severe neurological symptoms and signs such as seizures and stupor are also possible. Respiratory issues develop in a form of shortness of breath.[ic.steadyhealth.com]
  • Symptoms Abdominal pain Coughing Delirium Diarrhea Fever Metallic taste in mouth Mouth and throat pain No urine output Seizures Shock Shortness of breath Stupor Thirst Vomiting Home Treatment Seek immediate medical help.[indiatoday.intoday.in]
  • Severe Symptoms of Iodine Overdose If the overdose continues it can lead to: Abdominal pain Delirium Fever Lack of urine output Seizures Shock Swelling of face and body Shortness of breath Stupor Weak pulse Coma Japanese Kelp Consumption A type of acne[iodine-resource.com]

Workup

Iodine poisoning or iodine excess is diagnosed by evaluating patient's history. Consumption of iodine supplementation or excessive intake of iodine-rich food, previous radiologic diagnostic procedures or possible exposure to radioactive iodine, use of antiseptics containing povidone-iodine, and a history of arrhythmias should be taken into account when interviewing the patient. Specific biomarkers that lead to suspicion of thyroid disorders are available. These include:

  • Iodine concentration in the urine;
  • Thyroid stimulating hormone (TSH) levels regulating the production and secretion of thyroid hormones by the pituitary gland. Levels are heightened in case of hypothyroidism and decreased in cases of hyperthyroidism or thyrotoxicosis;
  • Thyroglobulin which is secreted into blood in small concentrations and
  • Thyroid hormone thyroxine (T4) and triiodothyronine (T3) concentrations in free form that correlate to the state of hypothyroidism or hypothyroidism;
  • A presence of goiter revealed by palpation. The thyroid gland is considered enlarged if a lobe of is bigger than a distal phalanx of a patient's thumb. Ultrasonography is recommended over palpation as it is a more accurate technique, although requires specific experience and skill [8].

Treatment

  • Apply this treatment only when the victim is alert but discontinue treatment when victim is vomiting or having convulsions. Activated charcoal is effective in decontaminating the stomach.[tandurust.com]
  • Treatment includes activated charcoal, breathing support (if necessary), fluids and milk and medications which deal with accompanying symptoms.[ic.steadyhealth.com]
  • Symptoms Abdominal pain Coughing Delirium Diarrhea Fever Metallic taste in mouth Mouth and throat pain No urine output Seizures Shock Shortness of breath Stupor Thirst Vomiting Home Treatment Seek immediate medical help.[indiatoday.intoday.in]
  • Radioactive iodine is used in the treatment of thyroid cancer. The antiarrhythmic drug amiodarone releases iodine and may cause either thyrotoxicosis or hypothyroidism after prolonged use.[mhmedical.com]
  • Additionally, treatment of Graves disease includes administration of iodine-containing agents that lower production of the thyroid hormones but increase iodine concentration, leading to possible toxicity.[symptoma.com]

Prognosis

  • The prognosis of Iodine Poisoning is dependent on the amount of substance consumed, time between consumption and treatment, severity of the symptoms, as well as general health status of the patient.[dovemed.com]
  • The patient may receive: Activated charcoal Breathing support Fluids and milk Medicines to treat symptoms Tube through the mouth or nose into the stomach to wash out the stomach ( gastric lavage ) Expectations (prognosis) How well a patient does depends[indiatoday.intoday.in]
  • Prognosis The prognosis for mineral toxicity due to sodium, potassium, calcium, and phosphate is usually excellent. Toxicity due to the deposit of calcium phosphate crystals is not usually reversible.[healthofchildren.com]
  • 9.1.1 Ingestion 9.1.2 Inhalation 9.1.3 Skin exposure 9.1.4 Eye contact 9.1.5 Parenteral exposure 9.1.6 Other 9.2 Chronic poisoning 9.2.1 Ingestion 9.2.2 Inhalation 9.2.3 Skin exposure 9.2.4 Eye contact 9.2.5 Parenteral exposure 9.2.6 Other 9.3 Course, prognosis[inchem.org]

Epidemiology

  • Infection Control & Hospital Epidemiology, 10 (10): 447-450. Gommolin IH (1987) Iodated glycerol-induced hypothyroidism. Drug Intell Clin Pharm, 21 : 726-727.[inchem.org]
Sex distribution
Age distribution

Prevention

  • To help prevent this kind of toxicity, the Institute of Medicine provided the guideline known as Tolerable Upper Intake Levels (TUL).[tandurust.com]
  • You should call if you have any questions about poisoning or poison prevention. You can call 24 hours a day, 7 days a week.[medlineplus.gov]
  • Iodine is used to prevent iodine deficiency and its consequences, including goiter.[webmd.com]
  • How to prevent Iodine Overdose? In order to prevent an overdose in iodine, these medications should be taken according to the prescription of the physician. No medications should be taken without the knowledge of the physician.[medicalfoxx.com]

References

Article

  1. Pearce EN, Andersson M, Zimmermann MB. Global iodine nutrition: Where do we stand in 2013? Thyroid. 2013;23:523–528.
  2. Kassim IAR, Moloney G, Busili A, et al. Iodine Intake in Somalia Is Excessive and Associated with the Source of Household Drinking Water. J Nutr. 2014;144(3):375-381.
  3. Luo Y, Kawashima A, Ishido Y, et al. Iodine Excess as an Environmental Risk Factor for Autoimmune Thyroid Disease. Int J Mol Sci. 2014;15(7):12895-12912.
  4. Kawashima A, Yamazaki K, Hara T, Akama T, Yoshihara A, Sue M, et al. Demonstration of innate immune responses in the thyroid gland: Potential to sense danger and a possible trigger for autoimmune reactions. Thyroid. 2013;23:477–487.
  5. Nobukuni K, Kawahara S. Thyroid function in nurses: The influence of povidone-iodine hand washing and gargling. Dermatology. 2002;204(1):99–102.
  6. Braverman ER, Blum K, Loeffke B, et al. Managing Terrorism or Accidental Nuclear Errors, Preparing for Iodine-131 Emergencies: A Comprehensive Review. Int J Environ Res Public Health. 2014;11(4):4158-4200.
  7. Leung AM, Braverman LE. Consequences of excess iodine. Nat Rev Endocrinol. 2014;10(3):136-142.
  8. Rohner F, Zimmermann M, Jooste P, et al. Biomarkers of Nutrition for Development—Iodine Review. J Nutr. 2014;144(8):1322S-1342S.

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Last updated: 2018-06-22 08:16