1253

Abstract

Introduction: Iodine is found in multiple dietary, medicinal, and commercial products. The recommended daily allowance of 150 mcg/day is optimized or exceeded in most western countries and humans appear to have a high tolerance when ingestion is less than 2 mg/day. Iodine crystals are also used in the production of methamphetamine, which can be used orally, intravenously, via inhalation, or snorted. Case History: This case report describes a 22 year old male with no significant past medical history who presents after orally ingesting a substance suspected to be methamphetamine found in a zip-lock bag on the side of a road and subsequently developing chills, fever, abdominal pain, tachycardia, nausea, vomiting, and diarrhea. On arrival the patient was tachycardic and tachypnic with a decreased oxygen saturation with a metabolic acidosis. The patient was oriented and responsive, but drowsy. On physical exam, he was in mild respiratory distress with diminished breath sounds in bilateral lower lobes. Chest radiograph indicated a pulmonary infiltrate in the right lower lobe and chest CT showed small bilateral pleural effusions with consolidation in the bases of both lungs. A urine drug screen was negative. On day 1 of admission, his WBC was 8.6 with bands of 47%, elevated AST of 330 IU/L and ALT of 303 IU/L,an increased serum creatinine of 1.4, and an INR of 1.4. The TSH was within normal limits. The patient was placed on levofloxacin for suspected pneumonia as well as supplemental oxygen and fluids. His symptoms resolved by day two, but his WBC increased to 20 with a fall in bands to 27%. On day three, bromide, lithium, and iodine levels were drawn due to the non-anion gap metabolic acidosis. Bromide and lithium levels were normal, but iodine level was elevated at 325 mcg/L. The patient’s leukocytosis and bandemia resolved on day four and the patient was discharged on amoxicillin/clavulanate 875/125 mg twice daily. The patient did not return for his clinic visit and was lost to follow-up. Literature Review: Relevant articles published between 1938 and 2010 were reviewed. Articles were identified through a Medline search using the key words iodine, methamphetamine, toxicity, oral, and ingestion. Discussion: This is the first documented case of acute iodine toxicity that is suspected to be due to oral methamphetamine ingestion. The patient’s substance abuse history,description of the product, and clinical presentation support the hypothesis that the ingested substance was methamphetamine. Iodine in contact with the gastrointestinal mucosa is bothersome in sub-lethal doses and results in gastrointestinal corrosion, abdominal pain, and vomiting. Subsequent hypovolemia and electrolyte imbalances can cause systemic effects including tachycardia and hepatic dysfunction. In cases of lethal ingestion, death occurs within forty-eight hours. Because of iodine’s almost immediate emetic effect, death from acute iodine toxicity is rare. However, methamphetamine use continues to rise, which may increase the potential of sub-lethal and lethal iodine toxicity from methamphetamine ingestion. Conclusions: Iodine toxicity is a potential complication of methamphetamine abuse. This case report describes a case of oral methamphetamine ingestion, but toxicity may be considered with any route of methamphetamine ingestion.