ACUTE REACTIONS TO UROGRAPHIC CONTRAST MEDIUM

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Abstract
Thirty-two thousand, nine hundred sixty-four consecutive patients were studied with reference to the incidence and clinical characteristics of reactions to a single urographic contrast medium. Mild side effects were recorded in 5.1 per cent and acute reactions in 1.72 per cent. Severe reactions occurred in 0.09 per cent with 1 death from cardiac arrest. Acute reactions are unpredictable on the basis of history or any known pretesting technique. Pretesting itself is hazardous and gives a false sense of security to both physician and patient. As a consequence of these facts, it is evident that the presently available pretesting techniques serve no useful purpose and should be abandoned. The first 9,934 patients were studied with special reference to an association between a history of "allergy" or "hypersensitivity" and acute reactions. Reactions were 2.5 times (3.0 per cent as compared to 1.2 per cent) more frequent in patients with a positive history of "allergy." No increase in severity of reactions was noted. With a history of prior mild to moderate reaction to urographic contrast medium, reactions occurred in 20 per cent. No evidence of increasing sensitivity with repeated use was found. It is concluded that neither a positive history of previous "allergy" nor previous mild to moderate reaction from contrast medium is a contraindication to excretory urography. Acute life threatening reactions, although very rare, can occur unexpectedly in any patient, at any time. The radiologic team doing excretory urography must be well trained in their recognition and treatment. Emergency equipment, adequate to cope with any reaction,2 must be on hand and available for immediate use in every radiologic suite where excretory urography is done.

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