Adverse reactions to contrast media: related to medium or procedure? Observations on a case

Abstract

Adverse reactions to intravascular contrast media are well documented (Andrews, 1974; Ansell, 1976; Lalli, 1980; Shehadi & Toniolo, 1980). However, allergic and toxic reactions to drugs have to be differentiated from adverse reactions to the procedure. To illustrate this, we report the following. In a Phase I tolerance and pharmacokinetic study, iopentol (Nycomed AS), a new 3.0 non-ionic contrast medium, was to be injected into 24 healthy male volunteers (Aakhus et al, 1987). As part of the study, eight subjects received normal saline intravenously. One of the volunteers was a 30-year-old healthy male. On the trial day, approximately 30 s after the start of the injection of normal saline into his left cubital vein, an adverse reaction occurred (Table I). The subject became pale and dizzy. Three minutes after venepuncture, the blood pressure had fallen to 69/45 mm Hg and the electrocardiogram (ECG) showed absence of the P-wave. The heart rate dropped slightly and the pulse was weak. The condition gradually improved and after 10 min the ECG was normal and blood pressure 121/68 mm Hg. No specific treatment was given. The results of some of the blood tests taken in connection with the trial appear in Table II.