Difference between revisions of "Contrast media"
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==Intravenous== | ==Intravenous== | ||
| − | + | ||
| − | File:Contrast CT.jpg|link= | + | ===CT=== |
| − | </ | + | {{Main|CT with IV contrast}} |
| + | [[File:Contrast CT.jpg|thumb|170px|[[CT with IV contrast]]]] | ||
| + | |||
| + | ====In low renal function==== | ||
| + | [[File:On the origin and progress of renal surgery, with special reference to stone in the kidney and ureter and to the surgical treatment of calculous anuria. Together with a critical examination of (14783803013).jpg|link=CT with IV contrast in low renal function|thumb|180px|right|[[CT with IV contrast in low renal function]]]] | ||
| + | {{Main|CT with IV contrast in low renal function}} | ||
| + | Decreased renal function and several other conditions increase the risk of '''contrast-induced nephropathy''', which is a potentially lethal renal injury to the kidney following intravenous radiocontrast.<ref name="RudnickFeldman2008">{{cite journal|last1=Rudnick|first1=M.|last2=Feldman|first2=H.|title=Contrast-Induced Nephropathy: What Are the True Clinical Consequences?|journal=Clinical Journal of the American Society of Nephrology|volume=3|issue=1|year=2008|pages=263–272|issn=1555-9041|doi=10.2215/CJN.03690907}}</ref> | ||
| + | |||
| + | ===Contrast medium reaction=== | ||
| + | {{Main|Contrast medium reaction}} | ||
| + | In a more severe reaction:<ref name=SURF>Unless otherwise specified in lists and table: {{cite web|url=http://www.mastcellssjukdom.se/wp-content/uploads/2015/12/Nationella_rekommendationer_%C3%B6verk%C3%A4nslighetsreaktioner_kontrastmedel__PDF_2014-10-17.pdf|title=Hypersensitivity reactions against contrast media - Swedish Society of Uroradiology [Swedish: Överkänslighetsreaktioner mot kontrastmedel – SURFs kontrastmedelsgrupp] ], 2014-10-17}}</ref> | ||
| + | *'''Adrenaline''' shot, 0.3-0.5mg in adults, given intramuscularly. | ||
| + | *Summon an '''anesthesiologist''' | ||
| + | [[File:Intramuscular site of adrenaline.jpg|thumb|center|150px]] | ||
| + | |||
| + | ;Prevention | ||
| + | {{Main|Prevention of contrast medium reaction}} | ||
| + | Before a contrast CT of a patient with known allergic-like or unknown-type of contrast reaction to the same class of contrast medium (such as iodinated), the American College of of Radiology recommends premedication with a glucocorticoid, preferably starting 12 or 13 hours before contrast administration.<ref>{{cite web|url=https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf#page=11|Page 9 in: Manual on Contrast Media|website=American College of Radiology, Committee on Drugs and Contrast Media|accessdate=2018-08-25}} Version 10.3. 2018. ACR </ref> | ||
| + | |||
| + | ===Hyperthyroidism=== | ||
| + | {{Main|Iodinated contrast and hyperthyroidism}} | ||
| + | Iodinated contrast can cause thyrotoxicosis in people with hyperthyroid diseases, mainly toxic multinodular goiter, Graves’ disease, or Hashimoto’s thyroiditis.<ref name="YıldızKuşkonmaz2016">{{cite journal|last1=Yıldız|first1=Sema|last2=Kuşkonmaz|first2=Şerife Mehlika|title= Effect of iodinated contrast media on thyroid: a brief review|journal=Journal of Health Sciences|volume=6|issue=1|year=2016|pages=12|issn=1986-8049|doi=10.17532/jhsci.2016.278}}</ref> | ||
==Peroral== | ==Peroral== | ||
| Line 14: | Line 35: | ||
==Rectal== | ==Rectal== | ||
| − | '''Rectally administered contrast | + | ===Projectional radiography and fluoroscopy=== |
| + | ;Choice of contrast medium | ||
| + | *'''Barium sulfate''' is generally used. | ||
| + | *An '''iodine'''-based contrast medium is used where there is a risk perforation, where barium may cause chemical inflammation.<<ref>{{cite web|url=https://radiopaedia.org/articles/ct-luminal-contrast|title=CT luminal contrast|author=Dr Vikas Shah ◉ and Dr Jeremy Jones|accessdate=2018-11-07|website=Radiopaedia}}</ref> | ||
| + | :However, 1-2% of oral iodine is absorbed in the gastrointestinal tract, and can potentially case a [[contrast medium reaction]].<ref>{{cite web|url=https://medicine.yale.edu/diagnosticradiology/patientcare/policies/oralcontrast.aspx|title=Oral Contrast Policies|website=Yale School of Medicine|accessdate=2018-11-07}}</ref> Also, it is more expensive than barium | ||
| + | |||
| + | ;Iodine-based | ||
| + | Recommended concentration: | ||
| + | :Adults: 70 mg iodine per ml, such as 240 ml of a 370mg/ml solution in 1,000 mL of tap water.<ref name="iodine" group="notes">370mg/ml for undiluted gastrografin: | ||
| + | *{{cite web|url=http://www.bayerresources.com.au/resources/uploads/pi/file9348.pdf|title=AUSTRALIAN PRODUCT INFORMATION - GASTROGRAFIN (Sodium amidotrizoate / Amidotrizoate meglumine)|website=Bayer|accessdate=2018-11-07}}< | ||
| + | Dosages: | ||
| + | *{{cite web|url=https://www.drugs.com/dosage/gastrografin.html|title=Gastrografin Dosage|website=Drugs.com}}Medically reviewed on December 2, 2017.</ref> | ||
| + | :Children over 5 years: 55 mg iodine per ml such as 90 ml of a 370mg/ml solution in 500 mL tap water.<ref name="iodine" group="notes"/> | ||
| + | |||
| + | ===[[CT scan]]s=== | ||
| + | ''Rectally administered contrast'' is indicated in cases where a suspicion remains of penetrating trauma to the colon where an initial CT shows no reason for immediate surgery.<ref>{{cite web|url=http://www.radiologyassistant.nl/en/p466181ff61073/acute-abdomen-role-of-ct-in-trauma.html#i466184acd2fdb|title=Acute Abdomen - Role of CT in Trauma|author=Stephen Ledbetter and Robin Smithuis|website=Radiopaedia|date=2007-08-02}}</ref> | ||
{{Bottom}} | {{Bottom}} | ||
Latest revision as of 14:10, 23 July 2019
Author:
Mikael Häggström [notes 1]
Contents
Intravenous
CT
- Main article: CT with IV contrast
In low renal function
- Main article: CT with IV contrast in low renal function
Decreased renal function and several other conditions increase the risk of contrast-induced nephropathy, which is a potentially lethal renal injury to the kidney following intravenous radiocontrast.[1]
Contrast medium reaction
- Main article: Contrast medium reaction
In a more severe reaction:[2]
- Adrenaline shot, 0.3-0.5mg in adults, given intramuscularly.
- Summon an anesthesiologist
- Prevention
- Main article: Prevention of contrast medium reaction
Before a contrast CT of a patient with known allergic-like or unknown-type of contrast reaction to the same class of contrast medium (such as iodinated), the American College of of Radiology recommends premedication with a glucocorticoid, preferably starting 12 or 13 hours before contrast administration.[3]
Hyperthyroidism
- Main article: Iodinated contrast and hyperthyroidism
Iodinated contrast can cause thyrotoxicosis in people with hyperthyroid diseases, mainly toxic multinodular goiter, Graves’ disease, or Hashimoto’s thyroiditis.[4]
Peroral
Rectal
Projectional radiography and fluoroscopy
- Choice of contrast medium
- Barium sulfate is generally used.
- An iodine-based contrast medium is used where there is a risk perforation, where barium may cause chemical inflammation.<[5]
- However, 1-2% of oral iodine is absorbed in the gastrointestinal tract, and can potentially case a contrast medium reaction.[6] Also, it is more expensive than barium
- Iodine-based
Recommended concentration:
- Adults: 70 mg iodine per ml, such as 240 ml of a 370mg/ml solution in 1,000 mL of tap water.[notes 2]
- Children over 5 years: 55 mg iodine per ml such as 90 ml of a 370mg/ml solution in 500 mL tap water.[notes 2]
CT scans
Rectally administered contrast is indicated in cases where a suspicion remains of penetrating trauma to the colon where an initial CT shows no reason for immediate surgery.[7]
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
- ↑ 2.0 2.1 370mg/ml for undiluted gastrografin:
- . AUSTRALIAN PRODUCT INFORMATION - GASTROGRAFIN (Sodium amidotrizoate / Amidotrizoate meglumine). Bayer. Retrieved on 2018-11-07.<
- . Gastrografin Dosage. Drugs.com.Medically reviewed on December 2, 2017.
References
- ↑ Rudnick, M.; Feldman, H. (2008). "Contrast-Induced Nephropathy: What Are the True Clinical Consequences? ". Clinical Journal of the American Society of Nephrology 3 (1): 263–272. doi:. ISSN 1555-9041.
- ↑ Unless otherwise specified in lists and table: . Hypersensitivity reactions against contrast media - Swedish Society of Uroradiology [Swedish: Överkänslighetsreaktioner mot kontrastmedel – SURFs kontrastmedelsgrupp ], 2014-10-17].
- ↑ Error on call to Template:cite web: Parameters url and title must be specified. . American College of Radiology, Committee on Drugs and Contrast Media. Retrieved on 2018-08-25. Version 10.3. 2018. ACR
- ↑ Yıldız, Sema; Kuşkonmaz, Şerife Mehlika (2016). "Effect of iodinated contrast media on thyroid: a brief review ". Journal of Health Sciences 6 (1): 12. doi:. ISSN 1986-8049.
- ↑ Dr Vikas Shah ◉ and Dr Jeremy Jones. CT luminal contrast. Radiopaedia. Retrieved on 2018-11-07.
- ↑ . Oral Contrast Policies. Yale School of Medicine. Retrieved on 2018-11-07.
- ↑ Stephen Ledbetter and Robin Smithuis (2007-08-02). Acute Abdomen - Role of CT in Trauma. Radiopaedia.
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