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JRCERT Update

Adverse Reactions to Contrast: A Review

Mild Reactions Moderate Reactions
Mild reactions typically are managed with supportive Moderate reactions typically require directed
care or minimal intervention (see Box). These patients medical therapy; the type used depends on the
often have self-limited problems and are released from patient’s signs and symptoms. Moderate reactions
care with mild, improving, or no symptoms of the initial can progress to severe reactions. Although monitor-
reaction. Treatment includes periodic monitoring of ing primarily is performed to document response and
vital signs and patient symptoms, primarily to document exclude progression, close and frequent monitoring
response and exclude progression. These patients usu- could help ensure that signs of sudden symptomatic
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ally require no additional treatment; however, treatment progression are not missed. Most moderate respons-
should be kept close by in case a patient’s condition wors- es require acquiring or maintaining IV access,
ens or fails to respond to conservative measures. 3 applying supplemental oxygen, and suctioning the
airway, if necessary. Table 1 reflects moderate reac-
Box tions and their respective treatment methods.
Mild Reactions to Contrast Media 3
ƒ Abnormal taste Severe Reactions
ƒ Anxiousness Without appropriate treatment, severe reactions
ƒ Chills pose a significant risk of death or lasting injury.
ƒ Facial flushing These reactions require rapid targeted medical ther-
ƒ Headache apy and higher levels of care, such as the emergency
ƒ Hives department or inpatient admission. In addition,
ƒ Itchy throat patients who have severe reactions, moderate
ƒ Mild hypertension reactions resulting in airway compromise, or hemo-
ƒ Nausea dynamic instability should not be exposed to the
ƒ Pruritus provoking agent again regardless of premedication.
ƒ Uncomplicated contrast extravasation Further development of conditions might warrant
ƒ Vasovagal response (bradycardia or hypotension) with the need to activate the emergency medical system,
spontaneous resolution rapid response team, and basic or advanced life sup-
ƒ Vomiting port. Table 2 reflects severe reactions and their
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ƒ Warm sensation respective treatment methods.

Table 1
Treatment for Moderate Reactions to Contrast Media 3
Moderate Reactions Methods
Anaphylactic (diffuse hives, pruritus, throat tightness, facial edema) O2, oral or IV diphenhydramine, IV or IM epinephrine
Abated vasovagal response after medical management (bradycardia Reverse Trendelenburg position, IV atropine, carotid massage
or hypotension)
Hypertensive urgency IV labetalol, sublingual nitroglycerin, IV furosemide
Chest pain O2, sublingual nitroglycerin, activate EMS or RRT
Persistent nausea and vomiting IV ondansetron, IV fluids
Contrast extravasation with transient neurovascular changes Frequent neurovascular checks, consult plastic surgery, or
send to the emergency department
Hypoglycemia Oral glucose, IV D5W, IM glucagon
Abbreviations: D5W, solution of 5% dextrose in water; EMS, emergency medical system; IM, intramuscular; IV, intravenous; RRT, rapid response team.

604 RADIOLOGIC TECHNOLOGY, July/August 2018, Volume 89, Number 6
Reprinted with permission from the American Society of Radiologic Technologists for educational purposes. ©2019. All rights reserved.