Abstract
One of the dangers of topical therapy in thermal injuries is absorption of the therapeutic agent with subsequent metabolic and toxic complications. Two patients, one 30 years old with a 75% burn, the second 72 years old with a 35% burn, were treated topically with povidone-iodine ('Betadine', pH 2·43). In both patients severe metabolic acidosis developed which could not be attributed to sepsis,hypo-volæmia, renal failure, diabetes, lactic acidæmia, &c. The acidosis associated with the 75% burn required large amounts of sodium bicarbonate to maintain pH at 7·35 and a serum-bicarbonate concentration of 15 mmol/l (meq/l); serum-iodine was 48 000 μg/dl (normal 4-8·5 μg/dl). Acidosis in the second patient was not as severe, and serum-iodine concentration reached 17 600 μg/dl. The rate of urinary excretion of iodine was 50·8 ±7·4 mg/dl and seemed to be fixed. Hæmodialysis was very effective in reducing serum-iodine concentration. Povidone was also systemically absorbed. The persistent acidosis could be caused by absorption of the iodine or the acidic povidone-iodine. Until the ætiology of the acidosis and renal damage is more clear, iodophors should not be used topically for burns greater than 20% of the body surface or in the presence of renal failure.
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