Treatment of a Contrast Reaction

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Contrast:
None

Technique:

In a Code
1. Trendelenburg (head down/feet up)
2. Oxygen 2 liters via nasal canula
3. Epinephrine IV -
Adult is 5-10 ml (0.5-1.0 mg) IV from 1:10,000 solution
Children is 0.1 ml/kg(0.01 mg/kg) IV from 1:10,000 solution (this is < 1/2 a TB syringe)
Children weight: At birth - 3-3.5 kg, At 6 months - 6 kg, At 9 months - 9 kg

Bronchospasm (patient is wheezing and short of breath and you hear rhonchi)

Adults:
2 liters Oxygen via nasal canula
Epinephrine 0.1-0.3 ml (0.1-0.3 mg) of 1:1,000 solution SQ q 15 minutes x 3 for total of 1 mg for moderate symptoms
Epinephrine 0.3-0.5 ml (0.3-0.5 mg) of 1:1,000 solution SQ q 15 minutes x 3 for total of 1 mg for severe symptoms

Note - Epinephrine should only be given IV in a patient with life threatening hypotension or in cardiac arrest
In these cases give Epinephrine 5-10 ml (0.5-1.0 mg) of 1:10,000 solution IV
Note - give Epinephrine 1-5 ml (0.1-0.5 mg) of 1:10,000 solution SQ if you don't have 1:1,000 solution
Epinephrine can cause hypertension, ischemia, arrhythmias [especially when given IV]

Infants
Epinephrine 0.1 ml/kg(0.01 mg/kg) of 1:10,000 SQ or 0.01 ml/kg(0.001 mg/kg) of 1:1,000 SQ to maximum of 0.5 mg

Laryngeal edema (patient has shortness of breath and hoarseness and a lump in throat, you hear inspiratory and expiratory stridor)
Consider intubation
Treatment same as bronchospasm Epinephrine-wise

Urticaria and Hives (patient itching, has red rash, raised welts)
Adults: (warning - Benadryl causes drowsiness)
Benadryl 25-50 mg po q 6-8 hour
Benadryl 10-50 mg IV or IM (deep)

Children:
Benadryl 12.5-25 mg po q 6-8 hour
Benadryl 1.5 mg/kg IV or IM (deep)

Benadryl comes in 10 mg/ml solution
Always observe patient to make sure they don't develop a more severe reaction

Nausea and Vomiting
Stop study
Provide a basin
Sit patient up to prevent aspiration
Observe to ensure more severe reaction does not develop

Hypotension (cardiac or hypovolemic shock, patient is restless or lightheaded, BP is down and pulse is up)
Give large volumes of normal saline (0.9% NaCl) quickly via 1 or more IV's that are greater than or equal to 18 gauge needles
Oxygen 2 liters via nasal canula
If no response goto Epinephrine 1-3 ml (0.1-0.3 mg) of 1:10,000 solution IV q 1-5 minute up to 1 mg

Vagal reaction (patient apprehensive, restless, pallor, sweaty, BP is down and pulse is down )
In mild reaction try Trendelenburg (feet up/head down) and volumes of normal saline (0.9% NaCl)
Otherwise give atropine 0.5-2.0 mg IV

Seizure
Supportive measures:
Ventilate
Prevent aspiration by putting right side down to empty stomach into duodenum
Valium (diazepam) 5-10 mg IV x 1 - lasts perhaps 15 minutes
Seizures have 0.01% incidence of occurring in normal people but have increased incidence in people with brain pathology

Contrast Induced Acute Renal Failure
Increasing age and increasing Cr lead to increased risk of acute renal failure after contrast
Other risk factors for acute renal failure are diabetes and dehydration
Incidence = 0.5% of patients
Symptoms: see oliguria and increasing Cr within 12-24 hours after contrast is given
Lasts less than 5 days and returns to normal in 2 weeks and has 5-10% mortality
Treat via fluid and electrolytes balance

Source: AJR:151:263-270, August 1988 "Treatment of Reactions to Radiographic Contrast Material"

Views to Take:
Not applicable

References:
See References Chapter.

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