Experimental Testing of Iodinated Contrast Media Before Human Testing

Towart, R.; Golman, Klaes

doi:10.1007/978-3-642-59814-2_4

Cited by 3 publications

(6 citation statements)

References 130 publications

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“…In patients with renal impairment and reduced glomerular filtration rate the excretion of ICM by the kidneys is prolonged and can last for several weeks. The extrarenal elimination through bile and intestine is also increased [3,4].…”

Section: Pharmacokineticsmentioning

confidence: 97%

“…The kidneys are the main route of elimination, less than 1 % of injected ICM being excreted extrarenally [4]. The elimination half-life following intravascular administration in patients with normal renal function is about 2 h, and 75 % of the administered dose is excreted in urine within 4 h [3,4]. In patients with renal impairment and reduced glomerular filtration rate the excretion of ICM by the kidneys is prolonged and can last for several weeks.…”

Section: Pharmacokineticsmentioning

confidence: 99%

“…Reverse diffusion from extracellular space to the plasma also takes place. Complete equilibrium between plasma and interstitial space occurs about 2 h after injection [3]. Continuous elimination of ICM from plasma into the urine occurs following the intravascular administration.…”

Section: Pharmacokineticsmentioning

confidence: 99%

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Adverse reactions to iodinated contrast media

2001

Eur Radiol

226

126

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Adverse reactions to iodinated contrast media (ICM) are more likely to develop in patients with asthma, a history of allergy or contrast reaction and in those who are debilitated or medically unstable. These reactions can be divided into renal and general, and the latter are subdivided into acute and delayed. Acute general reactions can be minor, intermediate or severe. Fatal reactions are rare. The introduction of low-osmolality agents has caused an overall reduction in the number of non-fatal contrast reactions. Prompt recognition and treatment of acute adverse side effects to ICM is invaluable and may prevent a reaction from becoming severe. Familiarity with cardiopulmonary resuscitation is essential for successful management of life-threatening reactions. Contrast-media-induced renal impairment can be reduced with the use of low-osmolality contrast media and extracellular volume expansion. The use of ICM in diabetic patients receiving metformin should be carried out with care to avoid metformin-induced lactic acidosis. However, this problem is mainly observed in patients with diabetic nephropathy.

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Section: Pharmacokineticsmentioning

confidence: 97%

Section: Pharmacokineticsmentioning

confidence: 99%

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Adverse reactions to iodinated contrast media

2001

Eur Radiol

226

126

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“…Diffusion into the extracellular space is slower in skin, fat and skeletal muscle. Complete equilibrium between plasma and the interstitial space occurs about 2 h after injection [7]. Most ICM are eliminated from plasma by the kidneys.…”

Section: Chemistry and Pharmacologymentioning

confidence: 99%

Intravascular iodinated contrast media and the anaesthetist

Dickinson

Kam

2008

Anaesthesia

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Summary The use of intravascular iodinated contrast media (ICM) in radiological investigations is common. Increasingly, anaesthetists and intensivists are involved in the care of patients undergoing these investigations. Whilst the use of ICM is generally safe there are important adverse effects that need to be recognised and measures instigated to prevent or treat these effects. In patients at risk of developing adverse reactions it is important to consider alternative modes of imaging so that ICM can be avoided. Strategies for the prevention of ICM nephropathy should be considered in all patients receiving ICM. Currently intravascular volume expansion with 0.9% saline has the strongest evidence base. The use of isotonic sodium bicarbonate combined with N‐acetylcysteine appears promising in providing further benefits. Although the use of N‐acetylcysteine alone has not been shown to significantly reduce the incidence of ICM nephropathy it is cheap, has few adverse effects and it would seem reasonable to continue its use in conjunction with intravascular volume expansion. The routine use of corticosteroid and antihistamine premedication is not always effective in preventing general adverse reactions.

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“…Reverse diffusion also occurs from extracellular space to plasma. A complete equilibrium between plasma and interstitial space is reached about 2 hours after injection [9]. The degree of internalization of these agents into intact cells is very low both in vivo and in vitro [10,11].…”

Section: Pharmacokineticsmentioning

confidence: 99%

Hypersensitivity Reactions to Iodinated Contrast Media

Guéant-Rodríguez¹,

Romano²,

Barbaud³

et al. 2006

CPD

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Adverse reactions after iodinate contrast media (ICM) administration have been observed, which can be classified as immediate (i.e., occurring within one hour after administration) and delayed or non-immediate (i.e., occurring more than one hour after administration). Even though the incidence of ICM adverse reactions has been significantly reduced by the introduction of non-ionic compounds, immediate reactions still occur in about 3% of administrations. Different pathogenic mechanisms have been suggested for ICM reactions, including immunologic ones. Basophils and mast cells participate in immediate reactions through the release of mediators like histamine and tryptase, whereas a T-cell-mediated pathogenic mechanism is involved in most non-immediate reactions, particularly maculopapular rashes. Skin tests and specific IgE assays are carried out to diagnose immediate hypersensitivity reactions, while both delayed-reading intradermal tests and patch tests are usually performed to evaluate non-immediate reactions. However, in vitro specific IgE assays are not commercially available. As far as in vitro tests are concerned, a response involving ICM-related T-cell activity may be assessed by the lymphocyte transformation test. Allergologic evaluation appears to be indicated in hypersensitivity reactions to ICM, although the sensitivity, specificity, and predictive values of allergologic tests have not yet been established. This paper summarizes the current state of the art and addresses the research that is still needed on the pathogenic mechanisms, diagnosis, and prevention of ICM-induced hypersensitivity reactions.

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Experimental Testing of Iodinated Contrast Media Before Human Testing

Cited by 3 publications

References 130 publications

Adverse reactions to iodinated contrast media

Adverse reactions to iodinated contrast media

Intravascular iodinated contrast media and the anaesthetist

Hypersensitivity Reactions to Iodinated Contrast Media

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