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Training materials are widely used in imaging, usually CT, MRI, X, and then an ultrasound. iodine contrast material is the most common form of displacement is used and helps to distinguish between normal and pathological development. common indication for MRI, including inflammatory, infectious and malignant. However, intravenous contrast can be seen when the risk may increase in value analysis.Patients with impaired renal function, independent examination or other test images can provide a proper analysis of the data.
iodine-based agent iodobenzoic acid 2,4,6-three. Administration of iodine contrast material pieces which are attached to the extracellular space, the amount of water that moves into circulation, mainly through the kidneys. iodine contrast agent can be classified as non-ionic and ionic.These high osmotic pressure (ionic monomer), or low osmotic pressure (ionic cent of non-ionic monomer iopromida For example, ion and nickel). Site osmolarity, viscosity, and iodine contrast, are closely related. Side effects of increased osmotic pressure. iodine content is not an independent indicator of adverse events.The was elected to two non-ionic low osmolarity and less.But quimiotoxicidad is more durable than the non-ionic monomers and expensive.
Iopamidol, non-ionic monomer is used, which is twice the osmolarity of plasma, the iodine concentration of 300 mg / ml. Iodixanol is a non-ion and nickel content of 300 mg iodine / ml is close to plasma osmolality (290 Eighth m / kg). Given rising costs, which are used specifically to show any osmolarity may affect the quality (eg, CT angiography and coronary heart disease, lower limb ischemia, severe).
Unlike the use of ionic liquids. Only iotroxato temporary removal of plasma proteins in bile, is approved for intravenous cholangiography in Australia.
iodine contrast media is
These drugs are mainly used for ultrasound (preparation of micro-bubbles) and magnetic resonance imaging agents such as gadolinium, and shorten the T1 relaxation MRI.The me°seglandi time.They sometimes used to reduce the digital angiography of people who are allergic to iodine contrast media X-ray. higher than required for an adequate solution.
Carbon dioxide is used in digital angiography compared with the reduction of iodine is contraindicated. However, significant technical limitations. It can not be used for angiography or displacement of the diaphragm from the right, in order to prevent ischemic stroke in a balloon.
Although the contrast agent is generally safe, side effects sometimes occur.
Allergy to contrast agents, including IgE-mediated reactions and non-Ig anafilàctiques and activating cells in the field of coagulation and cinines alternative methods and inhibits platelet function. 1
Mild reaction, unlike low-eighth occurs in less than 3% of patients and include rash, nausea, flushing or urtikaria.sedang and severe hypersensitivity reactions, including wheezing and bronchospasm, angioedema, coronary spasm, hypotension, cardiac arrhythmias, heart failure and lost consciousness.Other severe reactions are rare, occurring in less than a 0.04% non-ionic iodine administration. As a strong reaction to the number of deaths is small (less than one death per 100,000 patients). 2, 3
Inside, the death of the parents higher.Children administration of the contrast is significantly more sensitive to changes in fluid levels compared to the opposite treatment.
Even small quantities can lead to an injection of iodine contrast reaction.Test recommended.The opposite reaction may not occur immediately, but was postponed after an hour, sometimes a week can occur.These responses (2.5%), but not atopic potential T-cell-mediated and can be hives, rashes angioedema.The reaction makulopapular osmolality contrast MRI and related mig.La is the most serious life-threatening reactions can be avoided by using the mass lowosmolar contrast agents.
Previous reaction to contrast media is the most important risk factors and bring the absolute risk of 20-60%, when exposed to second. Asthma increases the risk dramatically, particularly the risk of bronhospasmi.Beeta-blockers are related to allergic reactions and may increase bronchial spasms. History of allergies to multiple times, increasing the risk of acute reaction to iodine contrast, 3-5 times. Vasovagal reactions may occur with intravenous contrast medium.
If reactions occur, the contrast agent intravenously graduated immediately.Despite mild symptoms are usually transient and resolved without specific treatment, reactions started during or immediately after the injection should always be considered, which is märkprogress.Vasovagal reactions were treated with lower body height and 0.6 mg of atropine, as indicated . Treat light-delayed hypersensitivity to oral antihistamines.
Reactions associated with bronchospasm and wheezing, stridor, and hypotension should be treated laringoespasme or other antihistamines, epinephrine, with or without oxygen and intravenous hydrocortisone. Intubation may be needed and medications may be necessary in severe cases, support for 2-3 days. Intramuscular adrenaline (1:1000) is the basis for the treatment of serious side effects, and may be repeated every 5 minutes if vaja.Algannus for adults is 0.25 to 0.5 mL for those weighing under 50 kg and 0.5 ml for those weighing more than 50 kg. Corticosteroids are useful for early treatment of non-IgE-mediated response to E, but believes that to prevent or reduce the symptoms is delayed. Most patients recover from their reactions, without long-term mortality. 4 patients who develop severe reactions should be encouraged to use the medical hoiatuskaardile.Tõsised reactions should be reported to the Drug Safety Authority (www.tga.gov.au / ADR / bluecard.htm).
Patients who have different reactions to contrast agents can not be applied so that the species should be included in the study. But when the intravenous iodine and other substances used in the eighth and small premedicació corticosteroid for 24-48 hours before surgery is widely practiced.
Contrast nephropathy due to
In this case, arterial vasoconstriction and tubular changes in glomerular hemodynamics because of the quality of the plasma oncotic pressure caused by kidney failure means kontras.Pada acetylcysteine (an antioxidant and vasodilator) and Fenoldopam (vasodilator) has been studied as a preventive strategy, without a positive outcome is uncertain. 5
Acute kidney injury in patients who can not be hydrated and has normal renal function who receive contrast material is less than 4 ml / kg. Mild renal insufficiency before contrast injection of the liquid means to prevent deterioration of renal function.
Research is not opposed to alternatives such as MRI, ultrasound and digital angiography, decrease carbon dioxide should be considered in patients with moderate or severe renal insufficiency. Dimeric media in favor of the non-ionic monomer contrast, more than the average due to contrast nephropathy. 6
Most conventional radiology, the hospital now has a database of measuring serum creatinine and estimated glomerular filtration rate (GFR) before injection media.This due to renal failure is a potential factor for hospital mortality and long-term mortality in adult patients with renal insufficiency than 60 FG lleu.7 When asked mL/min/1.72m 2He cautiously and patients must be adequately gadolinium or iodine contrast agent.
Metformin has been associated with some cases of renal failure and lactic acidosis in patients treated with contrast agents. When the contrast agent can cause kidney failure, metformin, the kidneys produce can reach toxic levels can cause lactic acidosis. Now comes the metformin suspended for at least 12 hours of training to obtain and achieve at least 36 hours after surgery and the serum creatinine did not return to. The second level of glucose control, the patient may need at this time.
The most important factor to reduce the displacement caused by kidney problems are:
avoid repeating frequent high doses of study
access to adequate intravenous fluids if necessary
The low utilization of non-ionic environment Osmo
the use of contrast agent diluted in a smaller volume of
Avoid the use of these drugs can cause renal vasoconstriction (non-steroidal anti-inflammatory).
In most cases, kidney function back to the summit without treatment.In severe cases, treatment is the same in patients with tubular necrosis from other causes.
Nefrogènica systemic fibrosis
nefrogènica agent gadolinium-related systemic fibrosis in patients with renal insufficiency. 8, 9 In most cases, people are getting high doses of CT angiography or digital reduction of gadolinium contrast, iodine, known as allergens.
Patients with creatinine clearance <30 ml / min is considered a high risk of fibrosis and risk of systemic nefrogènica completely.The gadolinium should be avoided in patients with FG than 60 ml / min who receive low-dose requirements for Gadolinium (0.1 ml / kg) are ignored. Studies gadolinium with mild renal impairment should be determined in clinical grounds.
Products By contrast, iodine and thyroid
Contrast iodine-induced thyroid gland is rare. Iodine has little effect in patients with normal thyroid function. Patients with multinodular goiter and Graves' thyrotoxicosis and those who are at higher risk should not receive contrast.
Patients with ADHD may be a crisis of thyroid, thyroid function tests are accurate, and could affect media.These intravenous contrast agent can affect the thyroid isotope studies of eight weeks. Thyroid carcinoma in patients scheduled for treatment with radioactive iodine should not get the difference, because it may delay treatment for eight weeks.
Extravasation of contrast media
New techniques CT angiographic injection of contrast media power, the increased volume and higher injection. Thus, a slightly higher extravasation of contrast medium within or near the site of injection. In severe cases, the risk of loss of skin, although less drug under Osmo.
The goal of treatment in order to reduce the metabolism of the skin with cold compresses for 20 minutes and increase the use of contrast medium, and large storage tanks and shit.
iodine contrast agents commonly used to shoot a different diagnosis modalities.The on the eighth floor, non-ionic monomer contrast agents at very low risk of serious side effects. Patients should be carefully assessed the risk factors, such as the history of reactions to contrast media, asthma, disease, paying special attention to kidney function and thyroid medications, and this time, everything metformin and beta-blockers. should be regarded as a severe allergy, anaphylaxis by intramuscular adrenaline.