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Re: The Dark Side of The Alternative Health Movement: Promoting Ingested Iodine
Forum: The Truth in Medicine
 
  • The Dark Side of The Alternative Health Movem...   Hveragerthi   30mo  2,286
    • Hv, ... ... Those writers are not reliable. ...   uchihaMadara   29mo  2,197
      • Those writers are not reliable. Reading their...   RRR Hveragerthi   29mo  5,067  
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        Hveragerthi
        Re: The Dark Side of The Alternative Health Movement: Promoting Ingested Iodine

        Date: 6/1/2012 3:45:34 AM   ( 29mo ago )
        Hits:   5076   Size: 47419 char.   Status:       RRR [Message recommended by a moderator!]
        Already alerted!   Already alerted!

        Those writers are not reliable. Reading their incomplete rhetoric and historic bashing of iodine/iodide AND curezone tends to get old. Each person's therapeutic range of iodine/iodide is different, it all depends on individualistic variables and applicable circumstances. There's too much bias on that site to merit serious rebuttal objectively (here too even), whether they are right or wrong.

        Bias can go both ways.  Look at the iodophiles here on Curezone.  You cannot even mention an adverse effect of iodine without them coming down on you until they feel they squashed you.  I mentioned some dangers of iodine such as the adverse effects of of too much iodine on Hashimoto's.

        So I would trust the claims of the link I posted over the iodine trolls here on Curezone anytime.  Especially when there are plenty of evidence readily available as to the dangers of iodine in levels much lower than the lowest levels the iodophiles here keep recommending.
         

        So what exactly in their article is unreliable in your view?

         

        Let's see what some of the medical abstracts show as far as toxicity:

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774547/

         

         

        http://www.inchem.org/documents/pims/pharm/iodine.htm 

        "Presentation, Formulation
        
                   Iodine is available in solid form, in solution, and in 
                   tinctures, e.g.
                   
                   Povidone iodine antiseptic solution, surgical scrub 7.5%, 
                   povidone iodine 200 mg pessaries, povidone antiseptic 
                   ointment 100 mg/g.
                   
                   Tincture of iodine, USP, contains 2% cent iodine and 2.4% 
                   sodium iodide diluted in 50% ethanol.
                   
                   Aqueous solutions of iodine are Strong Iodine Solution USP 
                   (compound iodine solution, Lugol's solution) containing 5% 
                   iodine and 10% potassium iodide, and Iodine Topical Solution 
                   (USP) containing 2% iodine and 2.4% potassium iodide. Aqueous 
                   Iodine Solution BP contains the same amount of free and 
                   combined iodine per ml (130 mg/mL) as does the USP Strong 
                   Iodine Solution. (Reynolds, 1993)
                   
                   Potassium iodide aqueous cough expectorant.
                   
                   Povidone-iodide (Betadine) is an organically bound iodide 
                   compound containing 1% iodine in a water soluble base. Other 
                   organically bound iodide compounds are undecoylium chloride, 
                   diiodo hydroxyquin, tetraglycine hydroperiodide (60% iodine). 
                   These organic iodide compounds release iodine slowly and have 
                   a toxicity of one fifth of their iodine content (Haddad & 
                   Winchester, 1983).
                   
                   Povidone iodine antiseptic solution and surgical scrub are in 
                   5 litre containers, pessaries, ointment (see 1.7).
        
            2. SUMMARY
        
               2.1 Main risks and target organs
        
                   Concentrated iodine is corrosive. Main risks in acute 
                   exposure to high iodine concentrations are largely due to the 
                   highly corrosive effect of iodine on the entire 
                   gastrointestinal tract and resultant shock. If rupture occurs 
                   mediastinitis or peritonitis develop.
                   
                   Target organs are mucous membranes of pharynx, larynx and 
                   oesophagus for the concentrated iodine, and thyroid for the 
                   diluted form as a systemic effect. Iodine is not a frequent 
                   cause of toxicity in the amounts available in the household.
              
               2.2 Summary of clinical effects
        
                   Ingestion of iodine may cause corrosive effects such as 
                   oedema of the glottis, with asphyxia, aspiration pneumonia, 
                   pulmonary oedema and shock, as well as vomiting and bloody 
                   diarrhoea. The CNS , cardiovascular and renal toxicity 
                   following acute iodine ingestion appear to be due to the 
                   corrosive gastroenteritis and resultant shock. Vomiting, 
                   hypotension and circulatory collapse may be noted following 
                   severe intoxication.
                   
                   Eye
                   
                   Eye exposure may result in severe ocular burns.
                   
                   Cardiovascular
                   
                   Tachycardia, hypotension and circulatory collapse may be due 
                   to the ingestion of concentrated corrosive iodine solutions.
                   
                   Respiratory
                   
                   Inhalation of iodine vapour may result in severe pulmonary 
                   irritation leading to pulmonary oedema.  Oedema of the 
                   glottis and pulmonary oedema have also resulted from oral 
                   ingestion.
                   
                   Neurological
                   
                   Headache, dizziness, delirium and stupor may be noted 
                   following severe intoxication.
                   
                   Gastrointestinal
                   
                   A severe corrosive oesophagitis and gastroenteritis 
                   characterised by vomiting, abdominal pain and diarrhoea may 
                   be noted following ingestion. The vomitus is blue if starch 
                   is present in the stomach. A metallic taste may be noted.
                   
                   Dermatological
                   
                   Dermal application of strong iodine solutions may result in 
                   burns.
                   
                   Chronic ingestion may result in iodism characterised from 
                   acne form skin lesions and other skin eruptions.
                   
                   Cutaneous absorption may be significant and result in 
                   systemic symptoms and death.
                   
                   Endocrine
                   
                   Hypothyroidism, as well as hyperthyroidism, has been 
                   reported.
                   
                   Immunological
                   
                   Hypersensitivity reactions including angioedema and/ or serum 
                   sickness-like reactions may be noted." 
         "Contraindications 
        
                   Iodine preparations should not be taken regularly during 
                   pregnancy and lactation.
                   
                   Because iodine may cause burns on occluded skin, an iodine-
                   treated wound should be covered with a light bandage. As 
                   iodine and iodides can affect the thyroid gland, the 
                   administration of such preparations may interfere with tests 
                   of thyroid functions (Reynolds 1989; McEvoy, 1990).
                   
                   Potassium iodide should not be used in adolescent patients 
                   because of its potential to induce acne and its effects on 
                   the thyroid gland (Bouillon ,1988).
                   
                   Iodine or iodides should not be administered to patients with 
                   a history of hypersensitivity to such compounds." 
         "Teratogenicity 
        
                   Iodides diffuse across the placenta. Infant and neonatal 
                   death from respiratory distress secondary to goitre has been 
                   reported in mothers taking iodides(Parmalee et al., 1940; 
                   Galima et al., 1962).
                   
                   Chronic topical maternal use of povidone-iodine during 
                   pregnancy has been associated with clinical and biochemical 
                   hypothyroidism in the infant (Danziger et al., 1987). 
                   Exposure to I 131 can damage or ablute the developing thyroid 
                   of the human foetus. Hypothyroidism, either congenital or of 
                   late onset, has been reported in at least 5 children whose 
                   mothers were exposed to I 131 during pregnancy (Shepard, 
                   1980)" 
         "Main adverse effects
        
                   Endocrine system effects
                   
                   Iodine and iodides produce goitre, hypothyroidism as well as 
                   hyperthyroidism. These effects have also been reported in 
                   infants born to mothers who had taken iodides during 
                   pregnancy (Reynolds, 1989).
                   
                   Side effects of iodine given for radioprotection
                   
                   In iodine-induced goitre and iodine-induced hypothyroidism, 
                   special risk groups are foetus and neonates. Iodine-induced 
                   hyperthyroidism special risk group are people living in 
                   iodine deficient areas and people with a history of 
                   hyperthyroidism, (Bouillon, 1988). Extrathyroidal side 
                   effects are gastrointestinal complaints (nausea, pain), taste 
                   abnormalities, cutaneous and mucous membrane such as 
                   irritation, rash, oedema (including face and glottis), 
                   allergic-like reactions such as fever, eosinophilia, serum-
                   sickness-like symptoms, vasculitis. Special risk groups are 
                   patients with hypocomplementic vasculitis, (Bouillon, 1988).
                   
                   Allergic effects
                   
                   Whether iodine is administered topically or systematically, 
                   iodine and iodides can give rise to allergic reactions: 
                   urticaria, angioedema, cutaneous haemorrhage or purpuras, 
                   fever, arthralgia, lymphadenopathy and eosinophile, acne-form 
                   or severe eruptions.
                   
                   Iodism effects
                   
                   A mild toxic syndrome called iodism results from repeated 
                   administration of small amount of iodine. Iodism is 
                   characterised by hyper-salivation, coryza, sneezing, 
                   conjunctivitis, headache, laryngitis, bronchitis, stomatitis, 
                   parotitis, enlargement of the submaxillary glands, skin 
                   rashes and gastric upsets, (Reynolds, 1989, Gosselin et al, 
                   1984). In rare cases jaundice, bleeding from mucous membranes 
                   and bronchospasm may occur. Inflammatory states may be 
                   aggravated by these adverse reactions, (Bouillon, 1988).
                   
                   Gastrointestinal effects
                   
                   Acute effects due to ingestion of iodine are mainly due to 
                   its corrosive effects or action which arises at least in part 
        
                   from oxidizing potential of this element on the 
                   gastrointestinal tract. Symptoms include a metallic taste, 
                   vomiting, abdominal pain, and diarrhoea. Oesophageal 
                   stricture may occur if the patient survives the acute stage, 
                   (Reynolds, 1989; Gosselin et al., 1984).
                   
                   Cardiovascular and respiratory effects
                   
                   Death may occur due to circulatory failure, oedema of the 
                   glottis resulting in asphyxia, aspiration pneumonia, or 
                   pulmonary oedema, (Reynolds, 1989, Sittig 1981).
                   
                   Kidney effect
                   
                   Anuria may occur 1 to 3 days after exposure, (Reynolds, 
                   1989)."  
         "Acute poisoning 
        
                   9.1.1 Ingestion
        
                         Ingestion of iodine may cause corrosive effects such as 
                         oedema of the glottis, with asphyxia, aspiration 
                         pneumonia, pulmonary oedema and shock, vomiting and 
                         bloody diarrhoea.  The CNS, cardiovascular and renal 
                         toxicity following acute iodine ingestion appear to be 
                         due to the corrosive gastroenteritis and resultant 
                         shock.  Vomiting, hypotension and circulatory collapse 
                         may be noted following severe intoxication.
        
                   9.1.2 Inhalation 
        
                         Inhalation of iodine vapour is very irritating to 
                         mucous membranes. Headache, dizziness, delirium, 
                         collapse and stupor, death due to circulatory collapse, 
                         asphyxia from oedema of glottis, aspiration pneumonia 
                         or pulmonary oedema has been reported. Occasionally 
                         haemorrhagic nephritis may occur within 1 to 3 days, 
                         oesophageal and pyloric stenosis have been reported, 
                         (Gosselin et al., 1984).
                            
                   9.1.3 Skin exposure 
        
                         Skin contact with iodine may give rise to 
                         hypersensitivity reaction, fever and skin eruption. 
                         Death following skin contact covering one third of body 
                         surface is reported to have occurred, (Gosselin et al., 
                         1984).
        
                   9.1.4 Eye contact 
        
                         Iodine vapour causes irritation and lachrymation in 
                         human eyes, (Grant, 1974).
        
                   9.1.5 Parenteral exposure 
        
                         Injection of iodine compounds may cause sudden fatal 
                         collapse (anaphylaxis) as a result of hypersensitivity. 
                         Symptoms are dyspnea, cyanosis, fall of blood pressure, 
                         unconsciousness and convulsions, (Dreisbach & 
                         Robertson, 1987).
        
                   9.1.6 Other 
        
                         No data available.
        
               9.2 Chronic poisoning 
        
                   9.2.1 Ingestion 
        
                         Repeated administration of small amounts of iodine may 
                         result in a mild toxic syndrome called "iodism". It is 
                         characterised by hyper-salivation, coryza, sneezing, 
                         conjunctivitis, stomatitis, parotitis, enlargement of 
                         the submaxillary glands, and skin rashes (Barker & 
                         Wood, 1940; Ehrich & Seifter, 1949).
                         
                         Hypotension, tachycardia, cyanosis and signs of shock 
                         are frequent symptoms of iodine ingestion. (Gosselin et 
                         al., 1984).
                         
                         Iodated glycerol used as a mucolytic expectorant in the 
                         treatment of respiratory disorders inhibited the 
                         biosynthesis of thyroid hormone and induced 
                         hypothyroidism (Drinka & Nolten, 1988; Gommolin, 1987).
                         
                         Amiodarone, an iodine rich drug widely used in the 
                         treatment of tachyarrhythmias, represents one of the 
                         most common sources of iodine-induced thyrotoxicosis 
                         (Martino et al., 1987; Regouby et al., 1985).
                         
                         Tablets of seaweed, sold over the counter, is one of 
                         the less common sources of iodine-induced 
                         hyperthyroidism (Shilo & Hirsch, 1990).
        
                   9.2.2 Inhalation 
        
                         No data available.
        
                   9.2.3 Skin exposure 
        
                          Intact skin
                         
                         Irritant contact dermatitis caused by povidone-iodine 
                         has been reported, (Okano, 1989). Liberal application 
                         of the tincture or povidone-iodine to the skin resulted 
                         in significant plasma and urine iodine levels and may 
                         cause systemic iodine toxicity (Luckhardt et al., 1920; 
                         Smerdely et al., 1989; Pyati et al., 1977; Chabrolle & 
                         Rossier, 1978; Coakley et al., 1989; L'Allemand et al., 
                         1987; Dantzigen et al., 1987; Schoenberger & Grim, 
                         1982).
                         
                          Injured skin
                         
                         Continuous postoperative wound irrigation with 
                         povidone-iodine resulted in death of a patient. Toxic 
                         manifestations of systemic iodine absorption appeared 
                         to cause the death, (D'Auria et al., 1990; Glick et 
                         al., 1985).
                         
                         Application of povidone-iodine on skin burns may cause 
                         systemic iodine toxicity (Lavelle et al., 1975; Peitsch 
                         & Meakins, 1976).
        
                   9.2.4 Eye contact 
        
                         Iodine-containing eye drops caused hyperthyroidism 
                         (Geisthoevel, 1984).
                         
                   9.2.5 Parenteral exposure 
        
                         Iodine-containing contrast media may cause 
                         hyperthyroidism; the most frequent thyroid disorders, 
                         usually of a temporary nature, occur after choledochal 
                         contrast media (Steidle, 1989). In premature infants 
                         they cause hypothyroidism (L'Allemand et al., 1987).
        
                   9.2.6 Other 
        
                         No data available.
        
               9.3 Course, prognosis, cause of death 
        
                   If the patient survives 48 hours after the ingestion of 
                   iodine, recovery is likely, although stricture of the 
                   oesophagus or pyloric sphincter may be a complication, 
                   (Dreisbach & Robertson 1987). It is probable that the 
                   pathological changes recorded in fatal cases of iodine 
                   poisoning and attributed to the systemic effects of iodine 
        
                   are largely the result of shock due to massive loss of fluid 
                   from the gastrointestinal tract and tissue hypoxia (Gilman et 
                   al.,1990).
        
               9.4 Systematic description of clinical effects 
        
                   9.4.1 Cardiovascular 
        
                         Cardiovascular effects are not due directly to iodine 
                         or iodide. Hypotension, tachycardia circulatory 
                         collapse may occur secondary to corrosive 
                         gastroenteritis due to ingestion of highly concentrated 
                         iodine solutions. In acute iodine inhalation, 
                         hypotension and tachycardia have been reported, 
                         (Gosselin et al., 1984).
        
                   9.4.2 Respiratory 
        
                         Inhalation of fumes leads to irritation of mucous 
                         membranes of the respiratory tract, which may result in 
                         asphyxia. Oedema of the glottis from ingestion was 
                         reported in early literature as a frequently mentioned 
                         cause of death, (Finkelstein & Jacobi, 1937).
                         
                         Pulmonary oedema and tachypnoea have been reported 
                         following ingestion of an unspecified large quantity of 
                         Lugol's solution, (Dyck et al., 1979).
        
                   9.4.3 Neurological 
        
                         9.4.3.1 Central nervous system (CNS) 
        
                                 Headache, dizziness and delirium have been 
                                 reported in severe intoxications.  Altered 
                                 sensorium (agitation, confusion, 
                                 hallucinations) have occurred in association 
                                 with elevated serum iodine concentrations, 
                                 (Alvarez, 1979; Gosselin et al., 1984).
                                 
                                 Continued administration of iodine may lead to 
                                 mental depression, nervousness and insomnia 
                                 (Reynolds, 1989).
        
                         9.4.3.2 Peripheral nervous system 
        
                                 No data available.
        
                         9.4.3.3 Autonomic nervous system 
        
                                 No data available.
        
                         9.4.3.4 Skeletal and smooth muscle 
        
                                 No data available.
        
                   9.4.4 Gastrointestinal 
        
                         Excessive ingestion of iodine solutions can lead to 
                         gastrointestinal irritation, vomiting and ulceration at 
                         various levels of the upper gastrointestinal tract. 
                         Late oesophageal and pyloric stenosis have been 
                         reported, (Gosselin et al., 1984).
                         
                         If the stomach contains starch the emesis is coloured 
                         blue.
        
                   9.4.5 Hepatic 
        
                         Elevated serum transaminases and bilirubin 
                         concentrations have been reported occasionally in 
                         patients with elevated serum iodine concentrations, 
                         (Lavelle et al., 1975; Peitsch & Meakins, 1976).
        
                   9.4.6 Urinary 
        
                         9.4.6.1 Renal 
        
                                 Poisoning is manifested by serum creatine and 
                                 levels up to 3.5 mg/dL (309 mmol/L) has been 
                                 reported, (Dela Cruz et al., 1987). The renal 
                                 lesions, which sometimes resemble acute 
                                 tubularnecrosis, may be exacerbated by 
                                 haemolytic anaemia, (Gosselin et al., 1984).
                                 
                                 Nephrotoxicity by iodine contrast media is 
                                 reported by  Cacoub et al., (1987).
        
                         9.4.6.2 Others 
        
                                 No data available.
        
                   9.4.7 Endocrine and reproductive systems 
        
                         Transient hypothyroidism characterised by elevated 
                         urinary iodide concentrations, elevated serum iodine 
                         concentrations, elevated TSH concentrations, and low T4 
                         concentrations have been demonstrated in povidone-
                         iodine exposed mothers and their infants (L'Allemand et 
                         al., 1987).
                         
                         Iodine induced thyrotoxicosis is a condition that may 
                         develop in older patients with long-standing iodine 
                         deficiencies who receive high doses of iodine 
                         (Kobberling et al., 1985; Fradkin, 1983; Klein & Levey, 
                         1983).
                         
                         Iodine containing drugs caused thyrotoxic crisis 
                         (Mackenroth, 1990).
                         
                         Excessive iodine intake can cause thyroid autoimmunity 
                         in endemic goitre, (Boyages et al., 1989).
                         
                         Organically bound iodine in the form of iodinated 
                         glycerol used as a mucolytic expectorant can inhibit 
                         the biosynthesis of thyroid hormone and induce 
                         hypothyroidism, (Drinka & Nolten, 1988).
                         
                         Hypothyroidism has also been described in neonates 
                         treated with topical povidone-iodine (Cosman et al., 
                         1988). Topical iodine containing antiseptics may induce 
                         hypothyroidism in very-low-birthweight infants, 
                         (Smerdely et al., 1989). Multiple applications of 
                         povidone iodine in pregnancy, and lactation caused 
                         transient congenital hypothyroidism in a 6 week old 
                         girl, (Danziger et al., 1987).
                         
                         Iodine in contrast agents and skin disinfectants is the 
                         major cause for hypothyroidism in premature infants 
                         during intensive care, (L'Allemand et al., 1987).
                         
                         Iodated glycerol, an organic form of iodine, prescribed 
                         as a mucolytic-expectorant induced a mild 
                         hypothyroidism in a patient with a previous history of 
                         severe potassium iodide-induced hypothyroidism.
                         
                         Amiodarone, an iodine-rich drug widely used in the 
                         treatment of tachyarrhythmias, represents one of the 
                         most common sources of iodine-induced thyrotoxicosis. 
                         It developed not only in patients with underlying 
                         thyroid disorders, but also in subjects with apparently 
                         normal thyroid gland. Thyrotoxicosis occurred either 
                         during treatment with or at various intervals after 
                         withdrawal of amiodarone. Classical symptoms were often 
                         lacking, the main clinical feature being a worsening of 
                         cardiac disorders, (Martino et al., 1987).
                         
                         Tablets of seaweed, sold over the counter, is a real 
                         source of iodine. A 72-year-old female developed 
                         hyperthyroidism while ingesting these tablets. After 
                         stopping, the symptoms of hypothyroidism disappeared, 
                         (Shilo & Hirsch, 1990).
                         
                         Continuous povidone-iodine irrigation caused iodine 
                         toxicity with symptoms of metabolic acidosis, changes 
                         in mental status and the patient died (Glick et al., 
                         1985).
                         
                         Administration of iodine containing eye-drops used as a 
                         cataract treatment caused hyperthyroidism (Geisthoevel, 
                         1984).
        
                   9.4.8 Dermatological 
        
                         A case of fatal dermatitis following the use of a 2.5% 
                         solution of resublimated iodine in pure industrial 
                         alcohol before a surgical operation has been reported. 
                         The reaction was thought to be due to idiosyncrasy to 
                         iodine. Skin disinfection with iodine has caused goitre 
                         and hypothyroidism in 5 of 30 newborns under intensive 
                         care (Bouillon, 1988).
                         
                         Prolonged exposure to tincture of iodine can induce 
                         superficial necrosis. At least one death has been 
                         reported consequent to extensive skin involvement. 
                         Solutions of iodine applied to the skin should not be 
                         covered with occlusive dressings.
                         
                         Topical application of povidone-iodine on burn patients 
                         may lead to increased iodine/iodide absorption (Lavelle 
                         et al., 1975) and the development of a metabolic 
                         acidosis, renal failure and an altered mental status 
                         although a cause and effect relationship has not been 
                         definitely established.
                         
                         The older literature reports systemic symptoms which 
                         occurred immediately to 24 hours later, rarely 
                         following cutaneous application of one-half to one 
                         normal strength iodine tincture. Symptoms included 
                         fever, diarrhoea, pain, headache and delirium. Skin 
                         eruptions included urticaria to erythema to exfoliative 
                         dermatitis. Mortality was 47% in those 15 cases 
                         reported (Seymour, 1937).
                         
                         Repeated applications of iodophors may cause contact 
                         dermatitis. Allergic reactions occur 12 to 20 hours 
                         after application (Harvey, 1985; Kudo et al., 1988).
        
                   9.4.9 Eye, ear, nose, throat: local effects 
        
                         Exposure to iodine vapour may cause burning in the 
                         eyes, blepharitis, and severe ocular burns (Finkelstein 
                         & Jacobi, 1937).
                         
                         Iodine vapour may cause rhinitis.
                         
                         Stomatitis and pharyngitis may result from exposure to 
                         iodine vapour or solutions and mucous membranes are 
                         coloured brown. (Finkelstein & Jacobi, 1937).
        
                   9.4.10 Haematological 
        
                          Neutropenia has been reported in association with 
                          elevated serum iodine concentrations, (Alvarez, 1979).
                          
                          Thrombotic thrombocytopenic purpura has been observed 
                          after repeated administration of small amounts of 
                          iodine, (Ehrich & Seifter, 1949)
                          
                          Haemolysis has also been reported (Dyck et al., 1979).
        
                   9.4.11 Immunological 
        
                          Reactions to iodine may occur acutely or after chronic 
                          use and may be characterised by coryza, headache, 
                          salivary gland pain, conjunctivitis, fever or skin 
                          reactions (urticaria, acneform, eruptions, erythema, 
                          bullous, ioderma). Oral and intravenous iodine 
                          containing radio-contrast media (e.g Telopaque (R); 
                          I125, I131) may cause iodine hypersensitivity reaction 
                          as well as anaphylactic type reactions, (Crocker & 
                          Vadam, 1963).
        
                   9.4.12 Metabolic 
        
                          9.4.12.1 Acid-base disturbances
        
                                   Metabolic acidosis may be associated with 
                                   iodine toxicity. There is an increased anion 
                                   gap due to elevated serum lactate levels (47 
                                   micromol/L) (Dyck et al., 1979; Dela Cruz et 
                                   al., 1987)
        
                          9.4.12.2 Fluid and electrolyte disturbances 
        
                                   Elevated serum sodium (hypernatraemia) (156 
                                   mEq/L) has been reported (Dela Cruz et al., 
                                   1987).
                                   
                                   Hyperchloremia (127 mEq/L) has also been 
                                   reported but probably represents a spurious 
                                   elevation due to interference in the assay by 
                                   iodine (Dela Cruz et al., 1987).
                                   
                                   Elevations in calculated osmolarity (340 in 
                                   Osm/L) have also been reported (Dela Cruz et 
                                   al., 1987).
        
                          9.4.12.3 Others
        
                                   No data available.
        
                   9.4.13 Allergic reactions 
        
                          Intolerance to iodised X-ray contrast media may cause 
                          reactions consisting of fever, chills, malaise, nausea 
                          and vomiting, skin rash, diarrhoea and even 
                          hypotension. These may be classified as idiosyncratic. 
                          In patients with a history of idiosyncratic reaction 
                          premedication with corticoids and histamines is 
        
                          indicated or non-ionic contrast reagents should be 
                          used,(Soyer & Levesque, 1990). After interleukin-2 
                          administration an increased incidence of 
                          hypersensitivity to iodine was observed, (Zukiwski et 
                          al., 1990).
                          
                          Hypersensitivity reactions were reported in 14 cases, 
                          secondary to the application of iodine-alcohol 
                          solutions to the skin. Symptoms reported were fever 
                          and generalised skin eruption of varying types. 
                          Despite the wide use of tincture of iodine the 
                          incidence of systemic reactions is low (Seymour, 
                          1937).
        
                   9.4.14 Other clinical effects 
        
                          No data available.
        
                   9.4.15 Special risks 
        
                           Pregnancy
                          
                          Maternal ingestion of iodine containing substances 
                          during pregnancy can cause (transient) primary 
                          hypothyroidism in the newborn, (Coakley et al., 1989).
                          
                          Exposure to iodine and radioactive iodine in pregnancy 
                          may lead to permanent hypothyroidism or goitre in the 
                          newborn. Such goitres may become very large and even 
                          create problems during delivery or mechanical 
                          compression during early postnatal life (Bouillon, 
                          1988).
                          
                           Breast feeding
                          
                          Similar warnings to those given for pregnancy against 
                          the use of iodine or iodine-containing drugs applies 
                          during lactation since iodine is actively secreted in 
                          milk, (Bouillon, 1988)."  
         "ILLUSTRATIVE CASES
        
                11.1 Case reports from literature 
        
                     Case 1
                     
                     Continuous irrigation with povidone-iodine in a 34-month-
                     old patient with mediastinitis was associated with iodine 
                     toxicity, resulting in fatalities, (Glick et al., 1985). It 
                     is suggested that povidone-iodine continuous irrigation of 
                     the mediastinum be a contraindication.
                     
                     Case 2
                     
                     A 63-year-old woman with a suppurative mediastinitis, 
                     treated with continuous Polyvinyl-pyrrolidone-iodine (PI) 
                     irrigation developed an acute oliguric renal failure due to 
                     systemic toxicity of PI. The withdrawal of PI was followed 
                     by a complete improvement of renal function, (Campistol et 
                     al., 1988).
                     
                     Case 3
                     
                     Two patients with leg ulcers got worse after the 
                     application of a compound mixture of sugar and povidone 
                     iodine (sugar/PI compound). Patch-tests showed positive 
                     reactions to 10% povidone-iodine in water and 5% potassium 
                     iodide in water with no response to sugar. They were also 
                     tested with sugar/PI compound containing 3% povidone 
                     iodine, resulting in another positive reaction. They 
                     improved after the application of sugar/PI compound was 
                     discontinued, (Kudo et al., 1988).
                     
                     Case 4
                     
                     A 34-year-old male with burns covering 80% BSA and a 22-
                     year-old female with a 45% BSA burn, showed hyperthyroidism 
                     induced by topical treatment with 1% povidone-iodine. After 
        
                     topical treatment with povidone-iodine was discontinued 
                     circulating thyroid hormones returned to normal values 
                     within weeks (Rath and Meissl,1988).
                     
                     Case 5
                     
                     Fifteen episodes of infection due to Pseudomonas 
                     aeruginosa, including peritonitis and other site 
                     infections, occurred in nine patients receiving continuous 
                     ambulatory peritoneal dialysis over a 27 month period. 
                     Occurrence of P. aeruginosa infection was significantly 
                     associated with use of povidone-iodine solution to cleanse 
                     the catheter site. Local irritation and alteration in skin 
                     flora caused by antiseptic solution or low-level 
                     contamination of povidone-iodine solution are potential 
                     mechanisms of infection (Goetz and Muder, 1989)
                     
                     Case 6
                     
                     Vaginal douching with polyvinyl pyrrolidone iodine (PVP-I) 
                     during pregnancy resulted in maternal iodine overload and 
                     increased the iodine content of amniotic fluid. The 
                     possible effect of this therapy was evaluated on the 
                     thyroid of the fetus by investigating 62 women with a mean 
                     duration of amenorrhoea of 20 weeks who solicited 
                     controlled abortion. Nineteen of them douched daily with 
                     PVP-I for 2 consecutive days before abortion (treated 
                     group). The other 43 women were not treated (control 
                     group). In both groups the iodine content was determined in 
                     the foetal thyroid and in amniotic fluid and maternal urine 
                     at the time of abortion. In addition, in the treated group 
                     the concentrations of iodine were also determined in 
                     amniotic fluid and urine before therapy and in urine after 
                     4 days of therapy. There were no differences in the 
                     concentrations of iodine in urine and amniotic fluid in the 
                     control group and in the treated group before therapy. 
                     Iodine content increased more rapidly in the treated group 
                     (from 1 to 7.7 micrograms) than in the control group (from 
                     1 to 2.5 micrograms) P less than 0.05  (Mahillon et al., 
                     1989).
                     
                     Case 7
                     
                     Approximately 570,000 newborns were tested for congenital 
                     hypothyroidism between May 1977 and December 1986. One 
                     hundred and sixty cases of primary hypothyroidism, were 
                     later found to be transient. 14 out of the transient cases 
                     were due to excessive intake of iodine. In two, this was 
                     due to maternal ingestion of iodide during pregnancy and in 
                     12 the babies received large amounts of topical iodine 
                     antiseptic. Two cases were caused by maternal anti-thyroid 
                     antibodies and in eight instances the cause was unknown. 
                     The large number of cases due to topical application of 
                     iodine antiseptic emphasizes the need for caution when 
                     using this substance in neonates (Coakely et al., 1989)."

         

        http://www.pro-lab.com/msds/stains_pl7052_7053_lugols_iodine_msds_eu.pdf

        "Revision Comments:

        Supplier's contact details amended. Reissued according to Regulation (EU) No 453/2010.

        Revision Date 11-2011

        Revision 3

        Supersedes date 02-2010

        Risk Phrases In Full

        R20/21 Harmful by inhalation and in contact with skin.

        R11 Highly flammable

        NC Not classified.

        R23/24/25 Toxic by inhalation, in contact with skin and if swallowed.

        R39/23/24/25 Toxic: danger of very serious irreversible effects through inhalation, in contact with skin and if swallowed.

        R50 Very toxic to aquatic organisms.

        Hazard Statements In Full

        H370 Causes damage to organs <>.

        H332 Harmful if inhaled.

        H312 Harmful in contact with skin.

        H225 Highly flammable liquid and vapour.

        H331 Toxic if inhaled.

        H301 Toxic if swallowed.

        H311 Toxic in contact with skin."

         

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