Acute kidney injury due to povidone-iodine ingestion

Abstract

Rationale:Povidone-iodine is a broad-spectrum antiseptic applied topically to treat wounds and prevent their infection. There have been several case reports of acute kidney injury (AKI) in burn patients after povidone-iodine irrigation and in patients receiving the substance as a sclerotherapy agent for management of lymphocele after renal transplantation. However, biopsy-confirmed AKI after ingestion of povidone-iodine has not previously been described.Patient concerns:A 47-year-old man who had apparently ingested povidone-iodine solution and presented with nausea, vomiting, and reduced urine output. Laboratory data revealed blood urea nitrogen of 124 mg/dL, serum creatinine of 6.3 mg/dL, impaired liver function, and leukocytosis. Urine iodine/creatinine ratio was markedly elevated.Diagnoses:Acute tubular necrosis and interstitial nephritis secondary to povidone-iodine ingestion.Interventions:The patient was admitted to the intensive care unit and underwent continuous venovenous hemodiafiltration. Kidney biopsy showed acute tubular necrosis and interstitial nephritis. Unstained sections showed tan objects in the tubular lumina that were suspected to be povidone-iodine casts. Corticosteroid therapy (1 mg/kg/day) was started after kidney biopsy.Outcomes:Renal function recovered after hemodialysis and corticosteroid medication, but not completely.Lessons:We have reported the first case of biopsy-confirmed AKI accompanied by increased urine iodine concentration following povidone-iodine ingestion.

Hypoxia, hypotension, and bradycardia induced by povidone‐iodine ingestion: A pediatric case report and literature review

“…12 PI ingestion induces acute kidney injury. 2 Fortunately, our patient lacked such injury, perhaps because he spat out most of the PI.…”

“…PI is a common surface disinfectant and antiseptic agent; [1][2][3] intoxication after ingestion can result in cardiovascular collapse, nausea, vomiting, acute renal failure, initial hyperthyroidism, metabolic acidosis, fever, liver function impairment, and iodine-induced hemolysis. 2,[4][5][6][7][8][9] Our case initially presented with hypoxia, hypotension, and bradycardia after PI ingestion. Other sequelae including aspiration pneumonitis and corrosive gastroenteritis developed in subsequent days.…”

“…Fortunately, no thyroid storm developed. [2][3][4][5][6][7][8][9] When managing PI poisoning, supportive care is key. 10 The airway must be maintained; we performed endotracheal intubation to treat the progressive airway edema.…”

Antiseptic Use in Orthopaedic Wounds

“…It is advisable to consider a number of circumstances where it may be detrimental, in particular with the use of Chlorhexidine and Hydrogen Peroxide within native joint cavities in view of their chondrotoxicity. Systemic complications such as thyroid [68,[72][73][74] and kidney [68][69][70][71] dysfunction, air embolism and even death have been reported [64][65][66][67]. There is strong evidence that skin preparation with antiseptics before orthopaedic procedures reduces the risk of post-operative infection.…”

Povidone-iodine solution as SARS-CoV-2 prophylaxis for procedures of the upper aerodigestive tract a theoretical framework

“…Cases of anaphylaxis, contact dermatitis and edema after exposure have also been reported [ 28 – 30 ]. Ingestion in high concentrations or quantities may lead to acute kidney injury and/or liver toxicity [ 31 , 32 ]. PVP-I in low concentrations has not been known to stain teeth [ 33 ].…”