10. Contrast Agents - Side Effects (including Prevention And Treatment) Flashcards
Ideal contrast medium:
Hemoisotonic + no undesirable effect
No contrast fullfill this requirement, but less SE with low-molecular contrast media (non-ionic iodine-based = low osmolality)
Reactions:
Anaphylactic - rare
Anaphylactoid - not dependant on osmolality/dose, even after 1ml
Timing:
After 5 min
After 48h - delayed reaction (headache, fever, hypotension)
Mild reaction: heat, redness, itching, sneezing, nausea, vomiting, cough, dyspnea, anxiety, hypotension
Severe reaction: bronchospasm, edema, cerebral spasms, cardiovascular collapse, shock, cardiac arrest
Barium - constipation, abdominal pain, toxicity, encephalopathy, peritonitis, adhesion, granuloma, endotoxic shock, aspiration pneumonia, allergy
Prevention:
Talk to patient, collect patient history
Explain benefits/risks of CM
Any CI —> alternative procedures (MRI, US)
Prophylactic medications: corticosteroids (USA normal, not in EU)
All nephrotoxic drugs STOPPED
Minimal amount of CM
If multiple studies —> enough time for kidneys to recover from CM
Well-hydrated, continue 2h after
Special caution:
Known side effects of CM
Renal disease —> nephropathy
Thyroid disease: not use iodine CM 3-6M before scintigraphy/radioiodine therapy
Breast-feeding period
DM2
Treatment:
Most acute iodine CM side effects: within 20 min
Room should have life support equipment
Examination: ABC, vital signs, brief history
Treatment: stop CM, monitor heart rythm, BP, SpO2
Bronchospasm: O2, salbutamol, severe-epinephrine
Laryngeal edema: epinephrine, severe-intubation
Pulmonary edema: elevate head, O2, furosemide, morphine
Hypotension: raise legs, fluids, O2, severe-dopamine
Vasovagal reaction: raise legs, fluids, O2, severe-atropine
Cardiac arrythmias: defibrillator
Seizure: turn on side (prevent aspiration), O2, diazepam
Nephropathy: watchful waiting, hydration, severe-hemodialysis
Itching/urticaria: antihistamines
