5.4. Deaths Related to Iodine Contrast Reaction
Despite the fact that deaths resulting from contrast media are rare, when they take place, they are associated with the elderly, the women and those with recurrent weakening medical conditions. Most deaths that occur as a result of contrast media are related to acute renal failure and anaphylaxis (Morcos, Bellin, Thomsen, Almén, Aspelin, Heinz-Peer & Stacul, 2014). An examination conducted on 48 deaths from contrast media revealed that renal failure took the biggest proportion at 58 percent, anaphylaxis and allergy ranked second at 19 percent, cardiopulmonary arrest was third at 10 percent, renal failure was fourth at 8 percent, and stroke and cerebral hypoxia ranked fifth at 4 percent. The figures are a highlight to the public proving the need for the society to tackle such effects and ensure that patients take due interest and initiatives to prevent such conditions to improve living conditions of the population and reduce adverse effects of the same. Ways of mitigating adverse reactions are of great importance as they help in preventing loss of lives and reduce degeneration of the health conditions to life-threatening conditions (Morcos, 2014).
5.5. Delayed Adverse Reactions
Although symptoms of adverse reactions of iodine-based contrast media is easily evident and appears within a short duration of time after the injection of the drug, there are cases that have delayed occurrence and can take up to one week to appear on the body. In Sweden, the delayed cases are more common in young adults, women and patients that have history of allergy (Meurer, Laniado, Hosten, Kelsch & Hogstrom, 2015). Another case of delayed reactions that has been witnessed in Sweden is the use of iso-osmolar nonionic media, moreover, the occurrence of delayed adverse effects is higher for the dimeric nonionic contrast media which rates at 10.9 percent while monomeric nonionic contrast media rates at 5.6 percent. Factors that influence the occurrence of delayed adverse reactions are such as previous delayed reactions and interleukin-2 therapy. Many of the delayed reactions result due to mediation of T-cells and are, in most cases, evident in skin reactions among them being erythema, angioedema, urticarial, and maculopapular rash (Meurer, Laniado, Hosten, Kelsch & Hogstrom, 2015). However, most of the delayed reactions are either mild or moderate and are self-limiting making it advisable not to carry out prophylaxis for the delayed reactions.
Extravasation of intravenous contrast drugs is also another issue for analysis in the society and this occurs under a very low probability as apparent in between 0.035 and 0.2 percent of patients that employ the use of mechanical power injectors. Factors leading to extravasation of contrast media are such as chronic illness, infancy, old age, debilitated patients, venous thrombosis, rapid injection rate, tourniquets, injections on dorsum of foot, ankle, and hand (Andreucci, Solomon & Tasanarong, 2014). In most cases, they appear as tenderness, burning pain, erythema and edema, there are also severe cases of the same, and such manifests as sloughing of the skin, serious injuries resulting in blistering, and compartment syndrome. Treating such conditions requires elevating of the affected extremity, ice packs and observing the affected areas for between 2 and 4 hours. It is advisable to carry out consultation on plastic surgery on the occasions when the extravasated media is more than 30 mL for ionic and 100 mL for the nonionic contrast media (Leung & Braverman, 2014).
5.6. Contrast induced nephropathy
There are occasions when effects acute adverse reactions of iodine-based contrast media cause nephrotoxicity; this is where renal function reduces due to the increase in baseline serum creatinine of about 0.5 mg/dL in a period of 48 hours after a patient has been injected with a contrast media (Biondi-Zoccai, Lotrionte, Thomsen, Romagnoli, D'Ascenzo, Giordano & Frati, 2014). In another way, nephrotoxicity can also lead to the increase of serum creatinine by more than 25 percent of the total amount, on the occasions when the baseline serum is less than 1.5 mg/dL otherwise greater than 1.0 mg/dL and the probability of nephrotoxicity is less when the patients has not experienced renal failure in the past and when such a patient shows bot signs or symptoms of renal failure in the body. When a patient has no history of renal failure, the probability of nephrotoxicity is less than 1 percent, but the percentage increases to between 12 and 27 percent when there is a condition of renal failure of renal impairment on the patient. Additionally, the probability of nephrotoxicity increases on the occasions when a patient has diabetic nephropathy to more than 50 percent (Thomsen, Bellin, Jakobsen & Webb, 2014). When patients with such conditions are injected with iodine-based contrast media, there is probability that effects are bound to rise proving the need to define the effects of contrast-induced nephrotoxicity.
Predisposing factors for the nephrotoxicity that result from the use of iodine-based contrast drugs are acute renal failure as a result of history of renal insufficiency, this is where there is a serum creatinine level of more than 1.5 mg/dL and this becomes more detrimental when the patient has various conditions among them being dehydration, diabetes mellitus, cardiovascular disease which involves the use of diuretics and old age of more than 75 years of age (Mariani, Guedes, Soares, Zalc, Campos, Lopes & Ribeiro, 2014). Moreover, other conditions that lead to the increase of the same are such as hyperuricemia and myeloma hypertension. Determination of whether the contrast media is either ionic or nonionic affects the probability of nephrotoxicity because the probability of patients with a history of renal failure and diabetes have higher chances of contacting the disorder when the contrast media is ionic than when the contrast media is nonionic. There is the need for the population to appreciate the benefits of iodine-based contrast media that are iso-osmolar, and nonionic proving the need for researchers to engage in additional research into the same and improve the health conditions of the population (Ghaghada, Sato, Starosolski, Berg & Vail, 2016).
With regards to pathogenesis, researchers posit that there is not clear thought on the contrast-induced pathogenesis, although suggestive ways include the decrease in renal perfusion that result from the direct contact with a contrast media on body organs such as the kidney and tubular cells. This is because release of endogenous vasoactive mediators which includes adenosine and endothelin and activation of the tubulo-glomerular feedback response leads to decrease in renal perfusion (Stacul & Bellin, 2014). Another cause of pathogenesis of nephrotoxicity induced by iodine-based contrast media is the decrease in the intrarenal production in vasodilators which comprises of nitric oxide and prostacyclin. With the various causes of nephrotoxicity caused by contrast media, there is need to highlight ways that the population can use to prevent the same and help in the improvement of health conditions of the population. One of the prophylactic measures that can be used to reduce the cases of contrast-induced nephrotoxicity is ensuring that patients are well hydrated and any cases of dehydration needs to be discouraged for the benefits of the population. Another way of prevention nephrotoxicity induced by a contrast media is the use of nonionic contrast media and patients need to ensure that the prophylactic procedures should be conducted between 6 and 12 hours before hydration (Beckett, Moriarity & Langer, 2015). However, such a process proves not practicable in some cases when an urgent use of iodine-based contrast drugs.
When conducting hydration of the patient, there should be administration of 0.45 percent of saline intravenously at 100 mL/ h between 6 and 12 hours before administration of the contrast media and the same needs to proceed for between 4 and 12 hours after the action of contrast induced treatments (Ramalho, Semelka, Ramalho, Nunes, AlObaidy & Castillo, 2016). There are some health facilities that employ the use of N-acetylcysteine for the purposes of providing prophylactic measures and prevent the adverse effects on the patients and ensure that they have a faster rate of improvement of health. It is not clear to suggest the use of N-acetylcysteine as a means of providing prophylactic treatment to the patients proving the need to increase such kinds of research works in the society. Provision of prophylaxis through the use of N-acetylcysteine requires patients to be given 600 mg of N-acetylcysteine two times in daily and for two days and the procedure should begin from one day before injection of iodine-containing contrast drugs. Another way is to inject sodium bicarbonate one hour prior to the injection of iodine-based contrast drugs the proceeding to the infusion of the same drugs 6 hours after treatment with the contrast drugs. Although such methods prove very effective in the provision of prophylactic treatment, there are inconclusive research on the same; this leads to suggestion of daily use of preemptive renal replacement therapy, theophylline and fenoldopam (Kanakia, Toussaint, Kukarni, Lee, Chowdhury, Khan & Sitharaman, 2016). Medics and researchers need to conduct additional research regarding the same and help in the improvement of the quality of health of the population and sensitize the population on the best ways of seeking treatment to various kinds of diseases in the society.
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