Radiology, Vol 162, 15-19, Copyright © 1987 by Radiological Society of North America
Life-threatening hypotensive reactions to contrast media administration: comparison of pharmacologic and fluid therapy
E vanSonnenberg, CC Neff and RC Pfister
Nine patients were studied retrospectively and 21 prospectively to
ascertain the effectiveness and complications of three therapeutic regimens
for life-threatening hypotensive reactions (systolic blood pressure 50 mm
Hg or less) to intravenous (IV) contrast media. Initial treatment was
pharmacologic in nine patients, with fluid in 14 and combined
fluid-pharmacologic in seven. All nine patients treated initially with
epinephrine required fluid volume administration to restore blood pressure.
Thirteen of 14 patients initially treated with fluids (0.5-3 liters)
required no other therapy. All patients treated with the combined regimen
responded satisfactorily. Complications of drug therapy included six-beat
ventricular tachycardia and ventricular bigeminy (epinephrine) and
exacerbated hypotension (diphenhydramine hydrochloride). No pulmonary edema
was encountered as a complication of fluid therapy. Fluid therapy, alone or
with drugs, with electrocardiographic monitoring appears to be a safe and
effective method of treating severe IV contrast agent-induced hypotension.
Pharmacologic therapy alone in the doses the authors used is often
ineffective and may cause major complications.
