A life‐threatening case of apparent systemic iodine toxicity associated with povidone‐iodine wound packing during a revision hip arthroplasty

Povidone-iodine solutions are used widely in clinical practice for a variety of antiseptic indications. In an era of increasing antibiotic resistance, they remain an essential tool in the treatment and prevention of wound infections. However, iodine species are easily absorbed systemically and there are reports of presumed iodine toxicity from povidone-iodine, including fatal outcomes. We present a case of a 64-year-old woman who suffered cardiovascular collapse after systemic absorption of iodine from wound packing during a revision hip arthroplasty. Features included hypotension, severe metabolic acidosis and renal injury associated with a urine iodine 413 times the upper limit of normal. Supportive care and high dose haemodiafiltration resulted in effective clearance of iodine, leading to full recovery. Thorough consideration and exclusion of other diagnoses are presented. This case highlights the under-recognised risk of systemic iodine absorption from the use of povidone-iodine. Further research is required to better understand the mechanisms of toxicity as well as the factors which influence systemic absorption of iodine and its effects.