Life-threatening hypotensive reactions to contrast media administration: comparison of pharmacologic and fluid therapy.

The 1982-1983 report by the United Nations Children's Fund (UNICEF) on the State of the World's Children recommended widespread implementation of oral rehydration as one of the four strategies projected to save the lives of 20,000 children each day.1 In the developing countries, oral rehydration has been shown to be an effective, simple, and inexpensive therapy for dehydration caused by severe enteritis in infants.2-8 The modern concepts of oral fluid therapy for diarrheal diseases evolved in part from the clinical observation that orally administered glucose-electrolyte solutions can replace diarrheal fluid losses in cholera. Previous laboratory investigation had demonstrated the presence of a cotransport system of sodium with glucose or other actively transported small organic molecules in the small intestine in animals and in man. Clinical studies suggest that this sodium-glucose cotransport system remains intact not only when the pathophysiologic agent is an enterotoxin, such as that elaborated by Vibrio cholerae or enterotoxigenic strains of Escherichia coli, but also with inflammatioion such as that associated with rotavirus, Campylobacter jejuni, E coli, and Yersinia enterocolitica.4-8 These observations have provided a physiologic rationale for an appropriately efficient ratio of sodium to glucose in formulating solutions to be used in the developing countries for oral therapy in the treatment of infants with life-threatening diarrheal dehydration. The question we address in this commentary is that of the appropriate implementation of oral hydration therapy in a developed country. Pediatricians and others concerned with the health of children in this country are not usually confronted with the problem of obtaining uncontaminated water nor with the management of large numbers of severely malnourished young infants with multiple health problems.

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Acute Life-threatening Reactions to Contrast Media

Australasian Radiology ◽

10.1111/j.1440-1673.1978.tb02092.x ◽

1978 ◽

Vol 22 (4) ◽

pp. 365-371 ◽

Cited By ~ 9

Author(s):

M. McD. FISHER

Keyword(s):

Contrast Media ◽

Life Threatening

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Severe and persistent hypoglycemia: a life-threatening adverse reaction of intravasation of hyperosmolal contrast media

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/00129689-200308000-00020 ◽

2003 ◽

Vol 13 (4) ◽

pp. 297-298 ◽

Cited By ~ 1

Author(s):

Adil Ceydeli ◽

James Rucinski

Keyword(s):

Adverse Reaction ◽

Contrast Media ◽

Life Threatening

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Obesity as a risk factor of contrast-induced acute kidney injury in patients with arterial hypertension and stable coronary artery disease

Systemic Hypertension ◽

10.26442/2075082x.2020.4.200546 ◽

2021 ◽

Vol 17 (4) ◽

pp. 63-67

Author(s):

Olga Iu. Mironova ◽

Olga A. Sivakova ◽

Viktor V. Fomin

Keyword(s):

Risk Factors ◽

Serum Creatinine ◽

Contrast Media ◽

Stable Coronary Artery Disease ◽

Kidney Injury ◽

Before And After ◽

The Difference ◽

Artery Disease ◽

Stable Cad ◽

Contrast Media Administration

Background. The prevalence of obesity in patients with stable coronary artery disease (CAD) and arterial hypertension (AH) is increasing each year. As the number of percutaneous coronary interventions requiring contrast media administration is rising in this group of patients, the risk of contrast-induced acute kidney injury (CI-AKI) remains high. The most important risk factors of CI-AKI in this group of patients remain to be determined as well as their prognostic significance. Aim. The aim of the study was to assess the role of obesity as a risk factor of CI-AKI in patients with stable CAD and AH. Materials and methods. 863 patients with stable CAD and AH were included in the prospective open observational cohort study (ClinicalTrials.gov ID NCT04014153). 398 patients were obese and 465 had body mass index (BMI) below 30 kg/m2. CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was the development of CI-AKI. Results. The rate of CI-AKI in patients with obesity was 12.6%, without obesity 12.7%, but the difference between groups was not statistically significant (p=0.935, 95% CI -0.0430.046). The rate of CI-AKI in male patients with obesity was higher than in female ones. The logistic regression model of CI-AKI development in patients with stable CAD, AH and obesity was build (AUC 0.9928, р0,0001, 95% CI 0.98191) and included age, weight, body mass index, female gender, heart failure, diabetes mellitus, proteinuria, anemia, baseline creatinine, contrast volume and the difference between baseline serum creatinine and creatinine level after the contrast media exposure. The baseline level of creatinine and the difference between the levels of creatinine before and after contrast media administration were statistically significant risk factors in the model. Conclusion. The rate of CI-AKI in patients with stable CAD, AH and obesity was 12.6%. The main risk factors of CI-AKI development in multiple logistic regression model were the baseline level of creatinine and the difference between levels of serum creatinine before and after contrast media administration.

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