Iodine poisoning is an acute or chronic intoxication provoked by the ingestion of an excessive amount of this substance. The main clinical manifestations include hypersalivation, burning and metallic taste in the mouth, swelling of the respiratory tract and lungs, impaired kidney function. Chronic lesions are characterized by hyperthyroidism. Pathology is diagnosed on the basis of anamnesis, clinical picture, venous blood mass spectrometry. Specific treatment: gastric lavage with sodium thiosulfate, starch in milk inside, if necessary – symptomatic and antitoxic therapy.
T50.9 Poisoning with other and unspecified drugs, medications and biological substances
Acute iodine poisoning is relatively rare. Specialists of toxicological centers are more likely to encounter cases of chronic intoxication provoked by improper preventive medication. Similar incidents are common throughout the United States. The number of patients increases in the spring, as many of them are trying to compensate for an imaginary or real deficiency of nutrients through their active use. Lethal changes occur with the simultaneous intake of 3 grams of the substance, signs of moderate exotoxicosis — at a plasma concentration of more than 60 mcg / l.
The most common cause of chronic damage is attempts at self—prevention of iodine deficiency without taking into account daily dosages. According to WHO recommendations, the average amount of iodine that an adult should consume per day varies between 160-200 mcg. The maximum allowable single dose is 1 gram. Taking 1 gram daily leads to poisoning. Other possible reasons:
- Industrial disasters. In case of emergency, the concentration of iodine in the ambient air increases, which causes inhalation poisoning. Signs of pathology occur in victims who have been in the zone with a chemical component content above 1 mg/m3 for a long time. The severity of the condition is directly proportional to the time spent in the infected space and the concentration of the xenobiotic.
- Contamination of drinking water sources. The release of I into water sources leads to acute poisoning. The maximum permissible concentration of the element in question is 0.125 mg/dm3. Exceeding these figures poses a danger to humans. Cases of chemical damage with the help of iodine-containing liquids were described during local military conflicts of the XX century.
- Radioactive disasters. They provoke the most severe intoxication, since radioactive iodine-131 spreads during accidents at nuclear power plants. Its accumulation in the thyroid gland causes radiation sickness, the formation of neoplastic changes. The ingestion of isotopes into the body is especially dangerous against the background of existing iodine deficiency.
- Processing of large surfaces. A certain excess of the norm of the element in the blood may occur with prolonged daily treatment of significant areas of the patient’s body with the drug. The degree of absorption increases when the drug is applied to the mucous membranes and wounds. With intact skin, systemic absorption is negligible. Normal indicators are restored independently 7-14 days after the last application of drugs.
- Accidental or intentional use. In casual cases, the antiseptic may be ingested by mistake. This becomes possible when the medicine is stored openly at home, where there are small children, old people suffering from senile dementia, mentally unhealthy people. It is impossible to exclude the use of the drug for suicidal purposes.
Prolonged iodine poisoning leads to the accumulation of its excess amount in the tissues of the thyroid gland. This provokes excessive production of thyroid hormones, enhances the transformation of androgens, is the cause of gynecomastia in men, accelerates energy metabolism, increases heat generation. The activity of the cardiovascular, urinary system is transformed. Possible violation of carbohydrate metabolism with the formation of diabetes mellitus. Mental disorders, loss of appetite caused by the toxic effect of hormones are determined.
In acute processes, intoxication phenomena come to the fore. The content of blood electrolytes changes, metabolic acidosis is formed. There is a disorder of the body’s receptor apparatus, the innervation of all organs and systems is disturbed. The vapors of the drug irritatingly affect the lungs, can provoke alveolar edema. Within a few days, kidney failure, anuria, and accumulation of metabolic products develop. Without medical care, death occurs on 3-10 days.
Iodine poisoning is divided into several principles. The main differentiation is considered to be the time of development of the clinical picture: acute and chronic type. In the first case, symptoms occur after 1-2 hours, in the second it takes several weeks or months. Pathology is also divided according to the ways of penetration of the poison:
- Oral. The toxicant is taken through the mouth, absorption occurs in the stomach. It is usually accompanied by signs of chemical burn of the mucous membrane and phenomena caused by the systemic poisoning effect of the drug. Liquid solution may enter the upper respiratory tract. It is realized with accidental ingestion of iodine and suicidal attempts.
- Inhalation. Occurs during industrial or radiation disasters. The substance sprayed in the air enters the lungs, irritates the alveoli, potentiates edema, respiratory failure. With a long-term stay in the emergency zone, the element is absorbed from the trachea and respiratory vesicles, which is accompanied by the development of general toxic symptoms.
- Transdermal. The poison penetrates through the skin, mucous membranes or tissues lubricated with antimicrobial solution. The condition can be observed in patients with severe injuries who need prolonged treatment with antiseptic medications. As a rule, chronic pathological processes are noted.
Mild pathology is manifested mainly by regional symptoms. The victim has swelling of the mucous membrane of the mouth, pharynx and upper respiratory tract. There are complaints of a burning sensation in the damaged area. The tongue is brown. Inhalation of vapors leads to coughing, shortness of breath, swelling of the vocal cords with the development of suffocation. The vomit has a bluish or brown color. There may be a moderate deterioration in general well-being, headache.
Moderate intoxication is characterized by the development of hematuria associated with damage to the renal tubules, indomitable thirst, diarrhea. Blood pressure rises, marked tachycardia is noted. Pyretic reactions are possible. Mental functions suffer: the patient is inadequate, delusions of persecution, psychosis, insomnia, categorical refusal to eat are revealed. Typical complaints about the irremediable taste of metal in the mouth. Additionally, all signs characteristic of mild exotoxicoses are determined.
Severe iodine poisoning causes the failure of the most important systems of the body. The patient is diagnosed with anuria associated with the development of acute renal failure, an increase in the size of the liver, signs of cardiovascular insufficiency, including collapse. With inhalation poisoning, moist large- or small-bubbly wheezes are ausculated, pronounced dyspnea of a mixed type, diffuse cyanosis of the skin is detected. Consciousness is disturbed or absent.
Chronic iodine poisoning is characterized by the absence of obvious acute manifestations. The main symptoms include a depressed psychological state, tearfulness, irritability, headaches, tremor of the extremities, tachycardia. The patient can lose weight while maintaining a normal appetite. Characteristic signs are the proliferation of thyroid tissue, exophthalmos, specific skin lesions, aseptic inflammation of the salivary glands, maxillary sinuses and mucous membranes of the respiratory tract.
The main complication of severe iodine toxicosis is multiple organ failure. There is a violation of the urinary, respiratory and cardiovascular systems. The prognosis for such conditions is extremely unfavorable. Pathological changes affecting three or more structures of the body lead to the death of the victim in 70% of cases. Patients who have been saved are often disabled, are unable to fully recover, and need constant care. The quality and duration of their life is drastically reduced.
Another complication, the possibility of which must be taken into account, is a thyrotoxic crisis. The problem occurs in patients suffering from a prolonged excess of iodine and diffuse toxic goiter. Under the influence of a provoking factor in such patients, a sharp release of a large amount of thyroid hormones occurs. The result is atrial fibrillation, tachycardia, multiple organ failure. In severe varieties of the disease, crises occur in 10-15% of cases.
The primary diagnosis is carried out by an ambulance doctor and a toxicologist who examines the victim. The toxicologist develops a plan for further examination aimed at assessing the severity of poisoning and identifying the affected structures. The basis for making a preliminary diagnosis is anamnesis, the appearance of the patient, the presence of clinical symptoms. The diagnostic search scheme includes the following methods:
- Physical. On examination, the skin is pale or cyanotic, breathing is rapid up to 25-30 times / minute. Systolic blood pressure usually keeps within 150-180, sometimes reaches 200 mm Hg. The mucous membranes of the mouth are colored brown, there are traces of chemical burns. Wheezing is heard in the lungs, the patient is restless, sometimes unable to adequately assess his own condition and the surrounding environment.
- Instrumental. According to abdominal ultrasound, hepatomegaly, moderate swelling of the intestinal loops is determined. With pulmonary edema, an overview radiography reveals merging shadows. With the development of exudative pleurisy, the fluid level is visualized inside the pleural cavity. The ECG shows the disappearance of the P teeth, the reduction of the R-R interval, rhythm disturbance, loss of part of the ventricular complexes.
- Laboratory. The concentration of I exceeds 60 micrograms/liter. Biochemical parameters depend on the degree of damage to visceral structures. There is an increase in the activity of liver enzymes, an increase in the concentration of creatinine and urea. The electrolyte composition of the blood changes, the amount of sodium increases, the hydrogen index shifts to the acidic side (metabolic acidosis).
The treatment plan depends on the type of intoxication, the presence of certain clinical signs, as well as on the conditions for the implementation of medical care. With pronounced changes, all initial measures are carried out by the ambulance team. It is not recommended to try to influence the patient’s condition on your own. Mild lesions allow for a number of measures to be carried out before the arrival of doctors. The final plan of drug correction is developed and carried out in the hospital.
Before the arrival of the ambulance, it is necessary to calm the victim, provide fresh air, give a cup of milk or water with the addition of starch to drink. It is not necessary to give solid food (raw potatoes) or try to rinse the stomach in a non-probe way. If there is a chemical burn in the esophagus or stomach, such actions will aggravate the situation and cause bleeding. With psychomotor agitation, soft fixation of the patient to the bed is allowed. If there is no consciousness, the patient is laid on his side and his condition is monitored.
Pre-hospital medical care
Oral iodine poisoning at the prehospital stage requires gastric lavage with a solution of sodium thiosulfate 5% to pure waters. It is better if the procedure is implemented through a thin nasogastric probe. After its completion, the patient is given to drink a starch solution in milk. Hospitalization in a toxicological hospital is indicated. During the transportation of a patient with a severe degree of lesion, vital functions are monitored, infusion therapy is performed through a peripheral venous catheter. If necessary, tracheal intubation is performed, sedative medications are administered.
The actions of hospital doctors are aimed at removing the toxicant from the body. Up to this point, the patient’s condition is medically maintained at an acceptable level. Bed rest and gentle nutrition are shown. With severe dyspepsia, hunger is prescribed in the first days. Reconvalescence takes about two weeks. The most severe cases require a long stay in a medical facility. The following types of therapy are recommended:
- Symptomatic. Maintenance of hemodynamics, correction of acidosis using sodium bicarbonate solutions, respiratory care. With pulmonary edema, loop diuretics and glucocorticosteroids are used, defoamers are introduced through respiratory equipment. An infusion of antiarrhythmics, antihypertensive medications, analgesics and neuroleptics may be required.
- Antitoxic. The removal of excess iodine is carried out using sodium thiosulfate. The drug is prescribed 10 ml every 4 hours. Non-specific detoxification methods are moderately effective. These include the introduction of a large amount of saline solutions with subsequent stimulation of diuresis, the appointment of activated carbon and other non-absorbable enterosorbents.
Chronic poisoning does not require emergency hospitalization. The patient is treated on an outpatient basis or is placed in a hospital as planned. The basis of therapy is the correction of existing hormonal disorders with the help of thyrostatic medications, refusal to use iodine—containing substances, symptomatic measures. Thyroid crisis is an indication for referral to the intensive care unit, where active antitoxic measures aimed at reducing the concentration of hormones are carried out.
Prognosis and prevention
The prognosis of iodine poisoning is favorable for mild, moderate and chronic intoxication. Timely correction of the condition ensures almost one hundred percent survival. Severe poisoning has a fairly high mortality rate. About 15% of the total number of cases ends with the death of the victim. Prognostically unfavorable situations are considered when a patient develops pulmonary edema, multiple organ failure, mental disorders.
Preventive measures provide for compliance with safety regulations when working in production using iodine. At home, it is necessary to keep antiseptics in closed cabinets. Prevention of iodine deficiency is carried out only according to the scheme proposed by the doctor. If there is a need for frequent treatment of large areas of the body with antimicrobials, the drugs need to be changed 1 time in 5-7 days. It is permissible to alternate iodine, diamond greens, chlorhexidine and other skin antiseptics.