How to remove accumulated iodine in burn-injured patients

Abstract

Background. Absorption of large quantities of iodine, as induced by the use of topical antimicrobial povidone-iodine in burn-injured patients, may cause metabolic and electrolyte abnormalities as well as renal failure. To diminish iodine levels, haemodialysis was previously reported to be a suitable therapy. We therefore studied the kinetics of iodine in order to define the most optimal dialysis strategy. Methods. Two patients with elevated iodine levels (93.6 and 81.2 mg/L) underwent continuous dialysis with blood flows Q B 150 and 120 mL/min. Blood was sampled from the inlet and outlet dialysis line at several time points during a 7-h and 39-h 10-min period, respectively. Samples were analysed for iodine with the inductively coupled plasma mass spectrometry (ICPMS) method. Kinetic analysis was performed using one and two compartmental models, deriving kinetic parameters: plasmatic volume V 1 , extraplasmatic volume V 2 and intercompartmental clearance K 12 . The calibrated kinetic model of Patient 2 was further used to simulate different dialysis strategies: 12-h per day with Q B 240, 6-h per day with Q B 480 and 240, and 12-h every 2 days with Q B 240. For each strategy, the mean average plasmatic and extraplasmatic concentration (TAC p and TAC ep ) was calculated during 48 h. Results. Iodine seemed to follow one compartmental kinetics when serum sample collections were limited to the first 7 h of dialysis (Patient 1), but iodine appeared to be distributed in two volumes (V 1 =19.4 L, V 2 =38.0 L and K 12 =55 mL/min) when a longer observation period was taken into account (Patient 2). The simulations disclosed that 12-h dialysis per day with Q B 240 or continuous dialysis with Q B 120 resulted in the lowest TAC p (18.2 and 19.0 μg/L) and TAC ep (34.4 and 36.1 μg/L). Conclusion. In patients with elevated iodine levels, especially when associated with renal failure, haemodialysis with a minimum 12-h duration with sufficient blood flow should be the first choice to remove iodine.

Clinical review: Use of renal replacement therapies in special groups of ICU patients

“…The molecular weight of iodine is 253; hence the dialyser clearance during high-flux dialysis is comparable with that of small solutes such as urea. Intercompartmental clearance is low, however, so long treatment times are mandatory [65]. Protracted high-flux haemodialysis or haemodiafiltration, with high blood and dialysate flow, is therefore the treatment of choice to remove iodine.…”

Can radioiodine be administered effectively and safely to a patient with severe chronic kidney disease?

“…The decrease in the glomerular filtration rate in CKD patients results in abnormalities in the excretion of iodine, with resulting increases in the serum levels and the total amount of iodine in the body . In healthy individuals, it was shown that radioiodine clearance reaches approximately 25–35% of endogenous creatinine clearance (i.e.…”

“…The decrease in the glomerular filtration rate in CKD patients results in abnormalities in the excretion of iodine, with resulting increases in the serum levels and the total amount of iodine in the body. 4 In healthy individuals, it was shown that radioiodine clearance reaches approximately 25-35% of endogenous creatinine clearance (i.e. it ranges between 30 and 40 ml/min), with approximately 56% of the administered dose excreted within 24 h and 80% excreted within 48 h. 11 However, in patients with ESRD, only 11% of the administered dose of the I-131 isotope is excreted within 24 h. Although excretion of the isotope by other routes, such as saliva, sweat and faeces, increases as renal failure progresses, but the level of excretion is not sufficient in comparison with the needs of the body.…”

“…A decrease in T3 and free T3 (FT3) levels is observed significantly more frequently in CKD patients than in the general population, most probably as a result of the impaired conversion of T4 to T3 . The concentration of iodine in the blood serum is also significantly increased in patients with CKD, mainly due to impaired excretion . It is estimated that decreased FT3 levels occur in approximately 25% of patients with advanced CKD, with goitre developing in as many as 40% of patients according to some data.…”

“…3 The concentration of iodine in the blood serum is also significantly increased in patients with CKD, mainly due to impaired excretion. 4 It is estimated that decreased FT3 levels occur in approximately 25% of patients with advanced CKD, with goitre developing in as many as 40% of patients according to some data. Multinodular goitre occurs at a significantly higher rate in CKD patients, and the risk of thyroid cancer increases.…”