Thyrotoxicosis induced by topical iodine application

Article Abstract:

Iodine intake is known to cause hyperthyroidism, and many cases have been documented following the administration of radiographic contrast media (used in X-rays and electronic imaging), cough medications, and application of iodide solutions to the skin. Recently, cases have been reported after the use of amiodarone, which is used to control irregular heartbeat (arrhythmia). Thyrotoxicosis, or Graves' disease, is characterized by hyperthyroidism, or an overactive thyroid. It sometimes runs in families, but generally the cause is not known, although it may be related to immune function. It is far more common in women than in men, and tends to affect those between 20 and 40 years of age, often after an infection or physical or emotional stress. Among the symptoms are nervousness, hand tremors, weight loss, tiredness, and heart palpitations. In older patients the symptoms are less clear, especially in the absence of goiter, an enlarged thyroid gland. These patients are likely to have cardiovascular symptoms, especially atrial fibrillation (a type of abnormal heart rhythm) and congestive heart failure. They may also have depression, muscle weakness, and neuropsychiatric symptoms. In the case described in this article, Graves' disease was probably made apparent by the administration of povidone-iodine soaks used to care for decubitus ulcers, commonly known as bed sores. The patient was difficult to diagnose because he did not have goiter, and his uptake of radioiodine was normal. Povidone-iodine soaks are often used for treatment of pressure or bed sores, and should be used with caution on patients with thyroid disorders. This is a case where there was no indication of a preexisting thyroid condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Physiological aspects, Development and progression, Iodine, Graves' disease

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Toxic dermatitis induced by 10-ethyl-10-deaza-aminopterin (10-EdAM), a novel antifolate

Article Abstract:

The drug 10-ethyl-10-deaza-aminopterin (10-EdAM) is a new analog of the anticancer agent methotrexate shown to be more effective than methotrexate against tumors in mice. The toxicity of this analog is similar to that of methotrexate. The dose of 10-EdAM is limited by the development of oral mucositis, the inflammation of the mucosal tissue in the mouth. In addition, the methotrexate analog can also cause myelosuppression, the inhibition of bone marrow function, and a reddening skin rash. The recommended dose of 10-EdAM is 80 milligrams per square meter of body surface given intravenously each week. Because this new analog is superior to methotrexate, one study compared the effectiveness 10-EdAM with that of methotrexate itself in treating cancer of the head and neck. During this study, the analog was shown to cause toxic effects on the skin that were different from the skin rash associated with methotrexate. Microscopic examination revealed that the toxic effect on the skin was a form of dermatitis (skin inflammation) that initially appears on the lower legs and later affects other areas of the body. Nine cases of toxic dermatitis associated with 10-EdAM treatment have been reported. Factors that increase the risk of developing 10-EdAM-related dermatitis have not be identified. Withdrawal of 10-EdAM treatment and the use of corticosteroids leads to healing of the dermatitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Antineoplastic agents, Skin, Dermatitis, Methotrexate

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Management of adrenaline (epinephrine) induced digital ischaemia in children after accidental injection from an EpiPen

Article Abstract:

The emergency departments worldwide encounter accidental digital auto-injection from an EpiPen injection. Out of various methods to reverse this effect, intradigital administration of phentolamine is the preferred management.

Management dynamics, Management, Usage, Dosage and administration, Company business management, Medical errors, Phentolamine, EpiPen Auto-Injector (Medication)

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