Accidental intrathecal injection of ionic water-soluble contrast medium: report of a case, including treatment

Abstract

We report a patient who inadvertently received a small amount of meglumine diatrizoate intrathecally. The physiopathology and treatment of this kind of accident are discussed.

Inadvertent Intrathecal Administration of Ionic Contrast Medium to a Dog

“…Aggressive control of seizures, usually with diazepam, is reported in all patients. In some, other anticonvulsant drugs such as phenobarbital, 13,[15][16][17] pentobarbital, 12,13 or phenytoin 13,15,16,18 were used simultaneously. In our dog, the administration of anticonvulsant drugs did not completely stop the spasms.…”

“…lower catheter. 10,16,19,21,25,26 Some patients in whom lumbar puncture and intrathecal lavage were not performed recovered, 15,17 but in those patients the amount of contrast medium injected was small. All patients with intrathecal lavage survived.…”

“…2 In both cases involving dogs, including this report, the animal completely recovered within 48 h. 1 In humans, among the 47 patients reported 16 patients died (approximately 33%). 11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Death occurred between 10 h 14 and 6 weeks 11 after the accidental injection. A smaller quantity of contrast medium seems to be associated with a better prognosis.…”

“…A smaller quantity of contrast medium seems to be associated with a better prognosis. 17,26,28 Ioxithalamate is thought to be less neurotoxic than diatrizoate, 29 perhaps because of its lesser affinity for dopaminergic receptors, 7 but among the three humans receiving ioxithalamate, two that received 10 ml or more died. 13,29 The one patient that survived had intrathecal lavage.…”

“…Since this ruling, eight more published accidents have occurred in humans. [9][10][11][16][17][18]20,21,31,32 To avoid accidental intrathecal injection of ionic contrast media, guidelines for use of contrast media have been suggested. 33 Staff should be told that Hypaque s or Te´le´brix s and Omnipaque s have different properties.…”