Iatrogenic reactions

Iatrogenic Reactions broadly refer to any adverse reactions that are unintentionally produced by physicians in their patients. For example, one of the side effects of many antihistaminic preparations (Hj antagonists) such as ethanolamine derivatives (prototype diphenhydramine) is heavy sedation. Although sedation may be desirable for some patients, it may interfere with daytime activities, and this needs to be considered when prescribing such medications. Other antihistaminic preparations (also 11 antagonists) such as piperidine derivatives (prototypes terfenadine or astemizole) have no sedative properties (Figure 3.2). 

In the past, boric acid was falsely considered to be relatively non-toxic, and had an unwarranted reputation as a germicide. However, it is only bacteriostatic, even in a saturated aqueous solution, and can cause adverse reactions. Boric acid has often proved poisonous, either by ingestion or after local use. Cases from the world literature have been reviewed (1,2). In 172 cases of boric acid intoxication, including 83 deaths, 37 deaths occurred after external use, including 23 children with nappy rash. From 1974 to 1984, the Poison Centre in Paris recorded 134 cases of intoxication with boric acid or borates, 88 of which were accidental and 31 iatrogenic. 

Adverse drug reactions are the most common iatrogenic illness, complicating, at times, up to 15% of therapeutic drug courses. Despite the frequency and sometimes life-threatening nature of ADRs, they remain underreported and thus are an underestimated cause of morbidity and mortality. 

ADRs are certainly the most important form of iatrogenic (i.e. doctor-induced) disease. Many of the serious reactions that occur are well-recognised and potentially preventable - e.g. bleeding with warfarin, the upper gastrointestinal effects of NSAIDs. In public health terms, it is not newly introduced drugs that are responsible for most of the population burden of adverse drugs reactions but those whose safety profile is well-established (see below). 

Kajander OA, Virtanen MP, Sclarovsky S, Nikus KC. Iatrogenic inverted takotsubo syndrome following intravenous adrenaline itq ections for an allergic reaction. Int J Cardiol 2013 165(l) e3-5. 

Bilomas result from rupture of the biliary system, which can be spontaneous, traumatic, or iatrogenic following surgery or interventional procedures (Mortele and Ros 2001 Murphy et al. 1989). Bilomas can be intrahepatic or perihepatic. Extravasation of bile into the liver parenchyma generates an intense inflammatory reaction, thereby inducing formation of a well-defined pseudocapsule. Clinical manifestations depend on the location and size of the biloma (Mortel and Ros 2001 Murphy et al. 1989). 

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