- Pregnant.
- Sickle cell anemia and multiple myeloma.
- Previous reaction
- Asthmatic patient, DM & Atopic dermatitis
- Renal impairment >> contrast might cause acute renal failure.
- Some drug which may cause adverse reactions in association with iodinated contrast: −e.g. Metformin Z
Type of reaction
Mild: Signs and symptoms appear self-limited without evidence of progression
- Nausea, vomiting -Altered taste -Sweats
- Cough -Itching -Rash, hives
- Warmth (heat) -Pallor -Nasal stuffiness
- Headache -Flushing -Swelling: eyes, face
- Dizziness -Chills –Anxiety.
Moderate: Reactions which require treatment but are not immediately life-threatening
- Tachycardia/bradycardia - Hypotension/Hypertension
- Moderate bronchospasm, wheezing -Dyspnea -Laryngeal edema
- Pronounced cutaneous edema
- treatment with antihistamine, hydrocortisone.
Severe: Life-threatening with more severe signs or symptoms including:
- Laryngeal edema
- Profound hypotension
- Unresponsiveness
- Convulsions (Severe or progressive)
- Cardiopulmonary arrest
- Clinically manifest arrhythmias
- Treatment with; Epinephrine, Atropine
Anaphylaxis: Occurs soon after injection
Contrast allergy premedication
Indication: individuals at high risk for severe repeat DHRs (e.g., anaphylaxis) to radiocontrast media.
Contraindication: history of severe reactions (e.g., SJS (Stevens-Johnson syndrome) after radiocontrast media.
- Prednison
Contrast-induced nephropathy
Definition: AKI after IV administration of iodinated contrast medium
Risk factors
-
Chronic kidney disease (CKD): diabetes mellitus, multiple myeloma
-
Congestive heart failure, arterial hypotension
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Nephrotoxic drugs: esp. NSAIDs
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Anemia
-
Dehydration
Course: Creatinine is highest 3–5 days after injury and usually falls back to the baseline level within 1 week.
Prevention of contrast-induced nephropathy
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Always evaluate kidney function before administering a contrast agent.
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Use a low dose and low concentration of contrast medium.
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The patient should discontinue nephrotoxic substances before administration.
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Ensure hydration: isotonic NaCl before and after administration of contrast medium