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Possible adverse reactions to IV contras media in a patient with renal cell carcinoma


possible adverse reactions to IV contras media in a patient with renal cell carcinoma

Intravenous contrast media refers substances used in various diagnostic procedures to improve the quality of images especially in radiologic studies. The use of IVs in radiology is generally aimed at making blood vessels more visible as Saljoughian (2012) expounds. There are basically two types of IV contrast media that are utilized in radiologic studies, namely; the ionic high-osmolality contrast media as well as non-ionic low-osmolality contrast media (Saljoughian, 2012). The use of the media may cause body reactions. IVs are used as injectables during radiologic sessions. Most of these IV contrast agents are iodinated and they can be utilized in any part of the body. They can be administered through arterioles, intrathecally, or through the abdomen. Their usage is grounded by their nature of being safe and with fewer side effects that are self limiting (Singh & Daftary, 2008, 69). Though the value of these substances has been widely recognized, they are not completely safe to use. Various risks have been associated with their use as discussed below.

Radiologists, basing themselves the nature of the iodinated contrast media and their mild reactions are still aware of the life-threatening reactions that may occur (Singh & Daftary, 2008, 69). This makes them be able to minimize these side effects, as well as manage them promptly in a strategic and systematic manner just in case they occur (Singh & Daftary, 2008, 70). Renal Cell Carcinoma (RCC) is a cancer of the kidney that emanates from the inside layer of the proximal convoluted tubule. These tubules are the ones that transport from the glomerulus the glomerular filtrate into the nephron limb. Renal Cell Carcinoma is also known as hypernephroma. The cancer is more pronounced in adults and about contributes to about 80 percent of the cases and of all urological cancers, it is the most fatal (Singh & Daftary, 2008, 71). To treat Renal Cell Carcinoma, radical nephrectomy or a partial one is employed and it has remained the main method of realizing a curative treatment. Although the cancer responds to immunotherapy in some cases, it exhibits resistance radiation therapy as well as chemotherapy.

Romans (2010, 3) explains that the contrast agents have osmolar properties that make them have higher particles than that of blood. It can also be the same as that of the blood. Its role is to prevent allergic reactions by the body against the contrast medium. They are also viscous in that their flow varies from different types of contrast media. Still, the viscosity can be decreased by heating to facilitate the flow of the liquid in the blood. Iodine is also known to reduce the viscosity of the substances in that the higher the iodine is concentrated, the more viscous is the solution of the contrast media (Romans, 2013, 3). Another property that makes the contrast media effective is their iconicity. This is the ability of the particles of the solution to disintegrate into ions or charged particles when they in solution form. Clearance is the other property of contrast media that makes them easy to be cleared form the body by being distributed over the extracellular space. Moreover, the clearance is made easy by the half life of the contrast media which is approximated to two hours as Romans (2013, 6) observes.

It is observed that a patient may nauseate, vomit, or experience a warm feeling (Singh & Daftary, 2008, 69). In general these signs do not last for a long time and thus the patient will not require treatment if the reaction is mild. If the reaction is moderate, the patient will experience the vomiting will be severe and there is a possibility of developing hives and even swelling. These come as a result of the production of histamine, a naturally occurring substance in the body. The reactions are referred to as idiosyncratic reactions which exhibit characteristics similar to allergic reactions or increased sensitivities to contrast media that is iodinated (Singh & Daftary, 2008, 69). This, as noted by Saljoughian (2012), occurs mostly in one percent of patients who receive contrast media and are frequently in need of treatment. 0.1 percent anaphylactic reactions can be experienced in patients receiving IV contrast media. It is however observed that one person out of seventy five thousand may die from these high reactions resulting from the two types of media (Saljoughian, 2012).

During a radiologic session, iodine-based liquid is injected into the vein. Ordinarily the iodine has a higher number of atoms compared to those in the body tissues. This phenomenon makes it denser to absorb X-rays during their penetration through the body tissues. Extravasations may occur while the contrast medium (iodine) is passed through the veins (Radiological Associates of Sacramento, 2012). There are chances of the contrast medium moving from the vein to leak into the tissues that surround it. In such circumstances, the leaking may result in bruising which in turn can bring about mild pain to the patient. This pain may be mistaken for something else so the patient should at least expect it before a treatment using IV contrast media as the Radiological Associates of Sacramento (2012) maintain.

Risk factors can make the patient more prone to serious reactions (American College of Radiology, 2013, 17). Allergy to the contrast media is one risk factor that will make the patient predisposed to particular reactions. Despite the fact that many patients experience allergies to contrast media, most of these are minor ones. If the patient has a high reaction to contrast media, there will be a possibility of experiencing reactions after undergoing the treatment (American College of Radiology, 2013, 17).There is also a risk of increased reaction if the patient has a cardiac disease. It is for this reason that administration is restricted to patients with normal pulmonary and cardiac functioning determined through formal pulmonary function and thallium stress testing. Symptomatic patients suffering from conditions like angina and those with acute aortic stenosis, hypertension, cardiomyopathy, and so on, are likely to develop contrast reactions. This may be as a result of using the contrast media’s osmolality that is uncontrolled. Anxiety in the patient is another factor that can accelerate the contrast reactions on the patient. Failure to determine the anxiety of the patient can cause him/her to have serious reaction to the IV contrast procedures (American College of Radiology, 2013, 18).

There are also specific reactions of the body that the patient may expect. If the patient has hyperthyroidsism, there is a possibility of intensifying toxicosis of the thyroid resulting into a life-threatening situation (Romans, 2013, 18). Pulmonary effects may also arise when iodinated contrast media are administered. If the patient has a pulmonary hypertension history, heart failure and the like are at a higher risk as Romans (2013, 18) reports. Pheochromocytoma, a tumour on the adrenal medulla can also result when catecholamines are secreted in excess. The use of HOCM has been observed to raise the circulation of catecholamines as reported by Newmark et al (2012, 669). Using of iodinated contrast media can initiate seizures in the patient if he has diseases disrupting the blood-brain barrier like metastasis, primary brain tumours (Newmark et al, 2012, 670). Delayed reactions, as Romans (2013, 18) explains may occur as reactions to the contrast media. They may appear after an hour or even a week from the time of injection of the contrast media. The patient may experience fever, pain on the arms, dizziness, nausea, urticaria and so on as reported by the American College of Radiology (2013, 22). Due to the above explained reactions, contrast media should be administered in a hospital setting. The procedure should be supervised by a well experienced and qualified physician to avoid adverse effects and enhance positive outcome.

To prevent the above contrast media reactions, a number of ways have been devised. Since extravasations can occur when the subcutaneous tissue is injected with contrast media, the use of mechanical injectors is reported to be more effective if applied in a more appropriate way. More care should be taken if there is use of HOCM (Romans, 2013, 34). Monitoring of the injection site is necessary. This can be done with an antecubital vein especially when initiating the injection. If there is a swelling on the site, it is a sign of extravasation and it is important to stop the injection immediately as Singh & Daftary (2008, 72) advise. Romans (2013, 34) continues to advise that contrast medium should be warmed using the body temperature in order to reduce its viscosity and make it flow easily through catheters. Moreover, he proposes the use of LOCM which less injurious compared to the HOCM on the subcutaneous tissue.

Risk factors such as allergy should be established before injection. Infants are at a higher risk of reaction, just as people above the age of sixty years. Females are in have higher chances of succumbing to reactions than males so care should be taken and close observation (Singh & Daftary, 2008). The medical conditions of the patient such as heart disease, renal diseases, diabetes, asthma et cetera should be established. The blood condition is also important to know if the patient has myeloma, polycythemia or sickle cell diseases. Any other contrast related cases should be established such as the injections less than 20mg of iodine, intra-arterial, previous reactions to contrast media and so on (Sing & Daftary, 2008, 70).

Although the preventive measures are necessary before administering an IV contrast media, sometimes reactions will occur, needing attention to be carefully managed. If extravasation occurs to a patient, it is important to assess its severity as well as the category of the reaction such as blood pressure, cardiac rhythm and so on, the call for assistance where necessary (Singh & Daftary, 2008, 72). Securing or improving the intravenous lines and the flow of oxygen is important in such cases. Drugs can be given without delay to the patient as well as monitoring and assessing to reassure the patient.

Air Embolism which involves symptoms like dyspnea, coughing, pains on the chest and hypotension is potentially fatal can be treated using 100percent oxygen that is placed on the left side of the patient as well as giving hyperbaric oxygen (Singh & Daftary, 2008, 72). Cases of delayed reactions which occur between one hour and a week are low. They are characterized by fever, rashes, pruritus, chills and nausea. These can be treated using a supportive therapy involving analgesics that treat fever, antipyretics to counter fever; hypotension can be treated with isotonic fluid, and rigours with meperidine. Contrast induced nephrotoxicity can be treated with medications after confirming the normal functioning of the kidney or the liver, usually after 48hours (Bae, 2010, 36). This is to avoid adverse effects which would result if the liver and the kidney are not functioning properly. If the patient is pregnant, the foeus or the embryo may be exposed to the magnetic field. Another risked posed to the pregnant women is contrast media diffusion through the placenta to the embryo (Singh & Daftary 2008, 71). Reactions in children are mostly anaphylactoid and they are mild. They cannot be easily detected so they can be treated as in adults while maintaining the dosage at a paediatric level as Singh & Daftary (2008, 72).

In conclusion to the discussion above, it is worthwhile to note that the reactions that occur after the injection of contrast media are either physiochemotoxic, or idiosyncratic. The former is concerned with the flow of the contrast media and its resistance, while the latter may be influenced by concentration of iodine. The latter are similar allergic reactions or oversensitivity to particular substances. Renal cell carcinoma which can cause renal failure needs an identification of its risk factors and then an administration of the IV contrast media for effective results. Still, it can be an easy way of appropriating the prevention and management of the effects of the treatment. Administration of intravenous contrast media should thus be done under supervision by qualified personnel with the above effects in mind to ensure the best outcome for the patient.


American College of Radiology. 2013. ACR Committee on Drugs and Contrast Media. ACR Manual on Contrast Media. Version 9, 2013.

Bae, Kyongtae.T. 2010. Intravenous Contrast Medium Adminstration and Scan Timing at CT: Considerations and Approaches. July 2010 Radiology. 256, 32-61.

Newmark, Jordan L, Mehra Ami., & Singla, A.K. 2012. Radiocontrast Media Allergic Reactions and Interventional Pain Practice – A Review. Pain Physician Journal. 15, 665-675.

Radiological Associates of Sacramento (RAS). 2012. CT Oral &IV Contrast Information. Accessed on August 14, http://www.radiological.com/services.aspx?page=id%7C6027

Romans, Lois E. 2013. The Use of Contrast Media in the CT Department. CEwebsource.com. May 15, 2013.

Saljoughian, Manouchehr. 2012. Intravenous Radiocontrast Media: A Review of Allergic Reactions. U.S. Pharmacist. Accessed on August 14, http://www.uspharmacist.com/content/d/in-service/c/34558/

Singh, Jagdish & Daftary Aditya. 2008. Iodinated Contrast Media and Their Adverse Reactions. Journal of Nuclear Medicine Technology. 36(2) 69-74.