Adverse Reactions from Contrast Media in Patients Undergone Computed Tomography at the Department of Radiology, Srinagarind Hospital
Background: The incidence of adverse reactions to iodinated contrast media has risen. The dearth of reports on reactions to the administration of iso- and low-osmolar contrast media should be addressed. We, therefore, studied the profile of adverse reactions to iodinated contrast media; viz., (a) the body systems affected (b) causality, (c) severity, and (d) preventability. Objective: To study adverse reactions (causes and severity) to iodinated contrast media at Srinagarind Hospital. Method: Between March and July, 2015, 1,101 patients from the Department of Radiology were observed and interviewed for the occurrence of adverse reactions. The patients were classified per Naranjo’s algorithm and through use of an adverse reactions questionnaire. Results: A total of 105 cases (9.5%) reported adverse reactions (57% male; 43% female); among whom 2% were iso-osmolar vs. 98% low-osmolar. Diagnoses included hepatoma and cholangiocarcinoma (24.8%), colorectal cancer (9.5%), breast cancer (5.7%), cervical cancer (3.8%), lung cancer (2.9%), bone cancer (1.9%), and others (51.5%). Underlying diseases included hypertension and diabetes mellitus type 2. Mild, moderate, and severe adverse reactions accounted for 92, 5 and 3%, respectively. The respective groups of escalating symptoms included (a) mild urticaria, itching, rash, nausea, vomiting, dizziness, and headache; (b) moderate hypertension, hypotension, dyspnea, tachycardia and bronchospasm; and (c) severe laryngeal edema, profound hypotension, and convulsions. All reactions could be anticipated per Naranjo’s algorithm. Conclusion: Mild to moderate adverse reactions to low-osmolar contrast media were most common and these occurred immediately after administration. For patient safety and better outcomes, improving the identification of patients likely to have an adverse reaction is essential.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1129588Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 723
 Department of Radiology, Srinagarind Hospital. Summary statistic of contrast media in Srinagarind Hospital January 2008 – December 2014. Khon Kaen: Faculty of Medicine, Khon Kaen University; 2015.
 Neuaithong K. Prevention guidelines for reducing adverse reaction from intravenous administration of Iodinated Contrast Medium (ICM). Srinagarind Med J. 2009;24(1):91–101.
 Cohan RH, Bullard MA, Ellis JH, Jan SC, Francis IR, Garner WL, et al. Local reactions after injection of iodinated contrast material: detection, management, and outcome. Acad Radiol. 1997;4(11):711–8.
 Wang CL, Cohan RH, Ellis JH, Adusumilli S, Dunnick NR. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. Radiology. 2007;243(1):80–7.
 Federle MP, Chang PJ, Confer S, Ozgun B. Frequency and effects of extravasation of ionic and nonionic CT contrast media during rapid bolus injection. Radiology. 1998;206(3):637–40.
 Nueaithong K. Adverse Reaction from intravenous administration of Iodinated Contrast Material in patient undergoing intravenous urography. Srinagarind Med J. 2012;27(3):288–98.
 Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology. 1990;175(3):621–8.
 Seong J-M, Choi N-K, Lee J, Chang Y, Kim Y-J, Yang BR, et al. Comparison of the safety of seven iodinated contrast media. J Korean Med Sci. 2013;28(12):1703–10.
 Subathra A, Sandhiya S, Kesavan R. An analysis of adverse drug reactions to radiographic contrast media reported during a 3 year period in a tertiary care hospital in south India. Indian J Physiol Pharmacol. 2014;58(1):45–50.
 Modi N, Vaidya K, Dudhia S, Shah R, others. A study of adverse drug reactions to radio contrast media in a tertiary care teaching rural hospital. Int J Med Sci Public Health. 2014;3(2):133–6.
 Bhowmick S, Bhat E, Panja B, Mukherjee S, Sikdar S, Biswas A, et al. A study on adverse drug reactions to non-ionic contrast medium in an Indian population: a 1-year experience. Int J Basic Clin Pharmacol. 2014;3:1066–71.
 Namasivayam S, Kalra MK, Torres WE, Small WC. Adverse reactions to intravenous iodinated contrast media: a primer for radiologists. Emerg Radiol. 2006;12(5):210–5.
 Caro JJ, Trindade E, McGregor M. The risks of death and of severe nonfatal reactions with high- vs low-osmolality contrast media: a meta-analysis. AJR Am J Roentgenol. 1991;156(4):825–32.
 Cochran ST, Bomyea K, Sayre JW. Trends in adverse events after IV administration of contrast media. AJR Am J Roentgenol. 2000;176(6):1385–8.
 Bush WH, Swanson DP. Acute reactions to intravascular contrast media: types, risk factors, recognition, and specific treatment. AJR Am J Roentgenol. 1991;157(6):1153–61.
 Thomson KR, Varma DK. Safe use of radiographic contrast media. Aust Prescr. 2010;33(1):19–22.
 Cutroneo P, Polimeni G, Curcuruto R, Calapai G, Caputi AP. Adverse reactions to contrast media: an analysis from spontaneous reporting data. Pharmacol Res. 2007;56(1):35–41.
 Singh J, Daftary A. Iodinated contrast media and their adverse reactions. J Nucl Med Technol. 2008;36(2):69-74-; quiz 76-7
 Zhang B, Dong Y, Liang L, Lian Z, Liu J, Luo X, et al. The incidence, classification, and management of acute adverse reactions to the low-osmolar iodinated contrastmedia isovue and ultravist in contrast-enhanced computed tomography scanning. Medicine. 2016;95(12):1-9.
 Maddox T G. Adverse reactions to contrast material: recognition, prevention, and treatment. Missouri: Am Fam Physician. 2002;66(7):1229-34.
 Tramèr MR, von Elm E, Loubeyre P, Hauser C. Pharmacological prevention of serious anaphylactic reactions due to iodinated contrast media: systematic review. BMJ. 2006;333(7570):675-80.