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How to remove accumulated iodine in burn-injured patients

Sunny Eloot (UGent) , Annemieke Dhondt (UGent) , Eric Hoste (UGent) , Alain Verstraete (UGent) , Jan De Waele (UGent) , Kirsten Colpaert (UGent) , Henk Hoeksema, Fiona Tromp (UGent) and Raymond Vanholder (UGent)
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Abstract
Background. Absorption of large quantities of iodine, as induced by the use of topical antimicrobial povidone–iodine in burn-injured patients, may cause metabolic and electrolyte abnormalities as well as renal failure. To diminish iodine levels, haemodialysis was previously reported to be a suitable therapy. We therefore studied the kinetics of iodine in order to define the most optimal dialysis strategy. Methods. Two patients with elevated iodine levels (93.6 and 81.2 mg/L) underwent continuous dialysis with blood flows QB 150 and 120 mL/min. Blood was sampled from the inlet and outlet dialysis line at several time points during a 7-h and 39-h 10-min period, respectively. Samples were analysed for iodine with the inductively coupled plasma mass spectrometry (ICPMS) method. Kinetic analysis was performed using one and two compartmental models, deriving kinetic parameters: plasmatic volume V1, extraplasmatic volume V2 and intercompartmental clearance K12. The calibrated kinetic model of Patient 2 was further used to simulate different dialysis strategies: 12-h per day with QB 240, 6-h per day with QB 480 and 240, and 12-h every 2 days with QB 240. For each strategy, the mean average plasmatic and extraplasmatic concentration (TACp and TACep) was calculated during 48 h. Results. Iodine seemed to follow one compartmental kinetics when serum sample collections were limited to the first 7 h of dialysis (Patient 1), but iodine appeared to be distributed in two volumes (V1=19.4 L, V2=38.0 L and K12=55 mL/min) when a longer observation period was taken into account (Patient 2). The simulations disclosed that 12-h dialysis per day with QB 240 or continuous dialysis with QB 120 resulted in the lowest TACp (18.2 and 19.0 µg/L) and TACep (34.4 and 36.1 µg/L). Conclusion. In patients with elevated iodine levels, especially when associated with renal failure, haemodialysis with a minimum 12-h duration with sufficient blood flow should be the first choice to remove iodine.
Keywords
burn injury, compartmental behaviour, dialysis strategy, POVIDONE-IODINE, ACUTE-RENAL-FAILURE, iodine, kinetic modelling, MEDIASTINAL IRRIGATION, HEMODIALYSIS DURATION, GUANIDINO COMPOUNDS, IMPACT, ABSORPTION, TEMPERATURE, KINETICS, INDUCTION

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Chicago
Eloot, Sunny, Annemieke Dhondt, Eric Hoste, Alain Verstraete, Jan De Waele, Kirsten Colpaert, Henk Hoeksema, FIONA TROMP, and Raymond Vanholder. 2010. “How to Remove Accumulated Iodine in Burn-injured Patients.” Nephrology Dialysis Transplantation 25 (5): 1614–1620.
APA
Eloot, Sunny, Dhondt, A., Hoste, E., Verstraete, A., De Waele, J., Colpaert, K., Hoeksema, H., et al. (2010). How to remove accumulated iodine in burn-injured patients. NEPHROLOGY DIALYSIS TRANSPLANTATION, 25(5), 1614–1620.
Vancouver
1.
Eloot S, Dhondt A, Hoste E, Verstraete A, De Waele J, Colpaert K, et al. How to remove accumulated iodine in burn-injured patients. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2010;25(5):1614–20.
MLA
Eloot, Sunny, Annemieke Dhondt, Eric Hoste, et al. “How to Remove Accumulated Iodine in Burn-injured Patients.” NEPHROLOGY DIALYSIS TRANSPLANTATION 25.5 (2010): 1614–1620. Print.
@article{833437,
  abstract     = {Background. Absorption of large quantities of iodine, as induced by the use of topical antimicrobial povidone--iodine in burn-injured patients, may cause metabolic and electrolyte abnormalities as well as renal failure. To diminish iodine levels, haemodialysis was previously reported to be a suitable therapy. We therefore studied the kinetics of iodine in order to define the most optimal dialysis strategy.
Methods. Two patients with elevated iodine levels (93.6 and 81.2 mg/L) underwent continuous dialysis with blood flows QB 150 and 120 mL/min. Blood was sampled from the inlet and outlet dialysis line at several time points during a 7-h and 39-h 10-min period, respectively. Samples were analysed for iodine with the inductively coupled plasma mass spectrometry (ICPMS) method. Kinetic analysis was performed using one and two compartmental models, deriving kinetic parameters: plasmatic volume V1, extraplasmatic volume V2 and intercompartmental clearance K12. The calibrated kinetic model of Patient 2 was further used to simulate different dialysis strategies: 12-h per day with QB 240, 6-h per day with QB 480 and 240, and 12-h every 2 days with QB 240. For each strategy, the mean average plasmatic and extraplasmatic concentration (TACp and TACep) was calculated during 48 h.
Results. Iodine seemed to follow one compartmental kinetics when serum sample collections were limited to the first 7 h of dialysis (Patient 1), but iodine appeared to be distributed in two volumes (V1=19.4 L, V2=38.0 L and K12=55 mL/min) when a longer observation period was taken into account (Patient 2). The simulations disclosed that 12-h dialysis per day with QB 240 or continuous dialysis with QB 120 resulted in the lowest TACp (18.2 and 19.0 {\textmu}g/L) and TACep (34.4 and 36.1 {\textmu}g/L).
Conclusion. In patients with elevated iodine levels, especially when associated with renal failure, haemodialysis with a minimum 12-h duration with sufficient blood flow should be the first choice to remove iodine.},
  author       = {Eloot, Sunny and Dhondt, Annemieke and Hoste, Eric and Verstraete, Alain and De Waele, Jan and Colpaert, Kirsten and Hoeksema, Henk and Tromp, Fiona and Vanholder, Raymond},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keyword      = {burn injury,compartmental behaviour,dialysis strategy,POVIDONE-IODINE,ACUTE-RENAL-FAILURE,iodine,kinetic modelling,MEDIASTINAL IRRIGATION,HEMODIALYSIS DURATION,GUANIDINO COMPOUNDS,IMPACT,ABSORPTION,TEMPERATURE,KINETICS,INDUCTION},
  language     = {eng},
  number       = {5},
  pages        = {1614--1620},
  title        = {How to remove accumulated iodine in burn-injured patients},
  url          = {http://dx.doi.org/10.1093/ndt/gfp647},
  volume       = {25},
  year         = {2010},
}

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