This is not as clear with the nonimmune-mediated anaphylactoid reaction and may explain the limited data supporting routine H2 blocker administration. Areas of focus include screening and patient selection strategies, premedication, and treatment of adverse events, including those related to renal function. Finally, the volume and route of administration of contrast also increase the likelihood of such reactions larger volume or intraarterial administration are more likely to produce a reaction ,. Consultation with the referring physician and radiologist, on a per-case basis, is necessary to develop guidelines that are in the patient's best interests. N Engl J Med 1996;334 9 :574—579.
The osmolality of a solution is the measurement of the number of molecules and particles in a solution per kilogram of water. Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse effects of contrast media: incidence, prevention and management. Review article: effects of radiographic contrast media on the lung. Increased risk for anaphylactoid reaction from contrast media in patients on beta-adrenergic blockers or with asthma. In severe cases of anaphlyactoid reactions, the basic principles of patient management for emergency situations in the catheterization laboratory apply.
Iodine absorption from the gastrointestinal tract during hypaque-enema examination. Also, the viscosity or thickness of the contrast media can cause resistance to its flow. Since the biologic half-life of iodinated contrast agents is less that 60 minutes, the amount remaining in the mother assuming her renal function is normal after 12 hours is essentially undetectable. Because contrast agents are associated with nephrotoxicity, it was postulated that the concomitant use of metformin and an iodinated contrast agent could lead to an increased risk of lactic acidosis. Anaphylactoid reactions to iodinated contrast media. Extravasation occurs when contrast material escapes the vascular lumen and infiltrates the interstitial tissue during injection. Abstract Cross-use of technology between nuclear medicine and radiology technologists is expanding.
There is now believed to be an extremely low passage of contrast into the fetal circulation, of which a very small amount is actually absorbed by the infant; although some mothers may cease breast-feeding for 24 h after contrast administration, the basis for this practice is questioned. Therefore, that particular contrast agent may be more radiopaque than a comparable low-iodine concentrated agent. J Allergy Clin Immunol 1991; 87:867-872. Small extravasations of contrast media usually produce a local inflammatory response in the skin, without serious sequela. Iodinated and gadolinium-based contrast media are used on a daily basis in most radiology practices. Arch Intern Med 2002; 162:329-336.
In short, the serum creatinine value is a reasonable screening parameter, since it is inexpensive and readily available, but it is not particularly accurate. A special pediatric code chart with appropriate doses and equipment should be maintained ,. Blood volume replacement in acute anaphylactic cardiovascular collapse related to anesthesia. However, the validity of this condition and the potential clinical effects are unknown ,. It is likely to cause no more than a transient increase in creatinine level while providing a definitive answer. Multiple myeloma and contrast media.
As will be discussed, the risk is confined to patients with underlying compromise of normal renal function ,. The major allergens in shellfish are tropomyosins, which are unrelated to iodine. It has also been proved effective, but with the major caveat that it is effective in preventing only minor adverse events. Mayumi H, Kimura S, Asano M, et al. The cardiovascular, respiratory, urinary, gastrointestinal, and nervous systems are most commonly affected by physiologic changes produced by contrast media.
The use of deep brachial intravenous catheters should be avoided because of the markedly higher relative risk of extravasation. These agents also impair migration of neutrophils, macrophage function, and both cytokine production and degranulation by mast cells, resulting in decreased effectiveness of the innate immune system, which typically activates immediately and independently of preformed antibodies. The parent molecule from which the contrast agents are derived is benzene. The incidence of intravenous contrast material extravasation usually is reported as less than 1% and is not directly correlated with injection flow rate. Additional concerns, as noted, are dehydration, poor renal perfusion as occurs with severe congestive heart failure , and the presence of other factors that may be nephrotoxic, such as certain medications or major surgery.
Patients at the greatest risk for moderate or severe breakthrough reactions include those with severe allergies to any substance or drug including iodinated contrast material, those who have more than four allergies, and those with chronic use of oral corticosteroids. List of Non-ionic iodinated contrast media: 10 generic name: generic name: generic name: generic name: generic name: generic name: generic name: generic name: generic name: generic name: generic name: generic name: generic name: generic name: generic name: ioxilan generic name: Further information Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. In combination with the standard steroid and H1 blocker regimen, nonionic contrast media was used in 181 intravascular studies of which 100 were intra-arterial. Air Embolism Air embolism is a potentially fatal but rare complication of intravenous contrast injection. Contrast-induced nephropathy has been shown to affect only people with very poor or deteriorating kidney function. Evaluation of intravascular low-osmolality contrast agents. Anaphylactoid reactions encompass an entire spectrum from cutaneous lesions, the most common, through severe reactions potentially culminating in eventual respiratory or vascular collapse Table I.
Currently, there is no agreement among physicians on the best treatment of intravenous contrast agent extravasation. Emerg Radiol 2006;12 5 :210—215. Nephrogenic systemic fibrosis and the use of gadolinium-based contrast agents. The latest edition of the Manual on Contrast Media provides more detailed information and references. The reactions usually resolve spontaneously and are treated with supportive therapy: analgesics to treat headaches, antipyretics for fever, meperidine for rigors, and isotonic fluid for hypotension. A small minority of severe reactions appear to be true allergic reactions, which are mediated by IgE and show positive results at skin testing ,. Assessment of the patient's pulse distal to the injection site and documentation of initial swelling and erythema are essential in early management.