Clinical Error - OMG

Another reason to avoid doctors' offices .....

"The physician prescribed 4 drops of Lugol’s solution to be given orally every 8 hours. The patient was inadvertently given an entire 100 mL container of Lugol’s solution in one dose— a total of 5 grams of free iodine."

http://www.ismp-canada.org/download/safetyBulletins/ISMPCSB2011-7-Iodine_Over...

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Holy smokes !! How does a person ingest 100ml of straight Lugol's solution ? That's like three fluid ounces.

If the MD wrote 4 drops every 8 hours, how spaced-out was the underling tht administered it, to interpret the MD's instructions as meaning one 100ml bottle instead of 4 drops every eight hours ?

Another reason to avoid doctors' clinics.

Well, they didn't die. It goes to show that even such a "large" amount can be non-fatal. Tweet