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Medline ® Abstract for Reference 7

of 'Immediate hypersensitivity reactions to radiocontrast media: Clinical manifestations, diagnosis, and treatment'

Ionic versus nonionic contrast media: a prospective study of the effect of rapid bolus injection on nausea and anaphylactoid reactions.
Federle MP, Willis LL, Swanson DP
J Comput Assist Tomogr. 1998;22(3):341.
PURPOSE: The purpose of our study was to evaluate the effect of bolus infusion of contrast medium (ionic versus nonionic) on the incidence of nausea and anaphylactoid reactions.
METHOD: We prospectively studied 1,827 patients who had bolus enhanced body CT scans and divided them into four groups: 725 patients received higher osmolality contrast medium (HOCM) at the slower bolus rate of 1-2.5 ml/s (SLOW-HOCM group); 650 patients were in the FAST-HOCM group and received the same ionic contrast medium at 4-5 ml/s; 250 patients received lower osmolality contrast medium (LOCM) at 1-2.5 ml/s, forming the SLOW-LOCM group; and 202 patients in the FAST-LOCM group got the same nonionic agent at 4-5 ml/s.
RESULTS: We found no significant difference in the rate of nausea among the first three groups: SLOW-HOCM (3.9%), FAST-HOCM (4.9%), and SLOW-LOCM (3.2%). A statistically significant lower incidence of nausea (0.5%) was found in the FAST-LOCM group. Anaphylactoid reactions were significantly more common in both groups who received HOCM (8.3 and 9.1%) compared with the groups who received LOCM (2.0 and 2.5%).
CONCLUSION: The bolus injection of warmed ionic contrast medium at a rate of 1-2.5 ml/s causes no significant increase in nausea compared with similar infusion rates of nonionic agents. For CT protocols that require infusion rates of 4-5 ml/s, the use of a nonionic agent is associated with a significantly reduced prevalence of nausea. The prevalence of anaphylactoid reactions is not affected by the rate of injection.
University of Pittsburgh Medical Center, PA 15213, USA.