Immediate Reactions to Intravenous Injection of Iodinated Contrast Media in a Tertiary Health Facility in Lagos, Nigeria

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Authors : Abonyi Livinus Chibuzo, Eze GO, Chukwudozie A.O



Adverse reactions to iodinated contrast media constitute a major challenge in radiography practice. This study was aimed at establishing the prevalence of such reactions in our environment so as to plan for more effective management.


A total of 750 patients were approached for this study, but only One hundred and fifty patients participated. They were those referred for Intravenous Urography (IVU) and Computed Tomography (CT) Scans involving intravenous injection of Urografin 76%, at the Lagos University Teaching Hospital (LUTH) Lagos, Nigeria. A semi-structured questionnaire was used to capture the patient’s demography, experience during the procedure and adverse reactions observed.

Data were analyzed using a soft ware package EPI Info 3.5.1 and results were tested at 5% level of significance.


A very high prevalence of immediate adverse reaction of 92.7% was revealed. Use of ionic, high - osmolar contrasts agent, level of anxiety, suspected poor storage condition and handling by the importing vendors accounted for this high degree. History of allergy had no significance, while rapid injection rate was associated with increased prevalence. Most adverse reactions occurred within 5mins of injection of the contrast medium.

Nausea (63%), and Dizziness (50.4%) were the most two adverse reactions that manifested.


Majority of patients in this study suffered adverse reactions due to the use of ionic contrast agent. Non ionic contrast agents should replace ionic contrasts, in spite of the high cost. However, adequate precautionary measures should be put in place if the use of ionic contrast agent is inevitable.


Acute adverse reaction, contrast media, radiographic procedures, risk factors.


1.      American College of Radiology (ACR) Manual of contrast media, 2010, Version 7.

2.      Ansell, G., Tweedle, M. C., West, C. R., Evans, P. & Couch, L. (1990). The current status of reactions to intravenous contrast media, Invest Radiol, 15: S32-S39 Medline.

3.      Beatriz, C.J. & Clarice, M.D. (2007) Immediate adverse reactions to intravenous iodinated contrast media in computed tomography, Revista Latino – Americana de Enfermagem, Vol. 15, No. 1 Ribeirão Preto. Jan/Feb.

4.      Christensen, C. (2005). X-Ray contrast media – an overview. Toxicology, 209, 185-7.

5.      Dickson, M. C. & Kam, P. C. A. (2008). Intravascular Iodinated contrast Media and the Anaesthetist, Journal of Anaesthesia, Vol.63 (6), 626-634.

6.      Djikmans, P. A., Visser, C.A. & Kamp, O. (2005). Adverse Reactions to Ultrasound contrast Agents: Is the Risk Worth the Benefit? European Journal of Echocardiography, volume 6, Issue 5, 363-366.

7.      Katayama, H., Yamaguchi, K., Kozuka, T., Seez, P. & Matsuura, K. (1990). Adverse reactions to ionic and nonionic contrast media: a report from the Japanese Committee on safety of Contrast Media : Radiology, 175, 621-628.

8.      Katzbery, R. W. (2008). Acute Reactions to Urography Contrast Medium: Incidence, Clinical Characteristics, and Relationship to History of Hypersensitivity States –A Commentary. American Journal of Roentenology, 190. 431.

9.      Lang, D. M., Alpern, M. B., Visintaine, P. F. & Smith, S. T. (1995). Gender risk for anaphylactoid reaction to radiographic contrast media, J Allergy Clinical Immunology; 95:813-7.

10.  Lasser, E. C. & Berry, C. C. (1989). Nonionic vs Ionic Contrast Media: What Do the Data Tell Us, American Journal of Roentenology, 152, 941-949.

11.  Lasser, E. C., Lyon, S. G. & Berry, C. C. (1997). Reports on contrast media reactions: analysis of data from reports to the U.S. Food and Drug Administration, Radiology, 203, 605-610.

12.  Maddox, T. G. (2002). Adverse Reactions to Contrast Material: Recognition, Prevention and Treatment, American Family Physician, Vol.66. No 7, 1229-1234.

13.  Manouchehr, S. (2012).Intravenous Radio-contrast Media: A review of Allergic Reactions. US Pharmacyst, 37(5), Hs14 – Hs16.

14.  Modi, D. J., Mahyavanshi, D. K., Kotecha, J. K., Ashutosh, D. & Harshad, S. (2012). Adverse reactions to intravenous iodinated contrast media: a prospective study, International Journal of Basic & Clinical Pharmacology, Vol. 1, Issue 3, 211- 215.

15.  Morcos, S. K. (2005). Acute serious and fatal reactions to contrast media: our current understanding. The British Journal of Radiology, 686-693.

16.  Morco, S. K. & Thomsen, H. S. (2001). Adverse reactions to iodinated contrast media. Euro Radiology, 12, 2600-2605.

17.  Morcos, S. K., Thomsen, H. S. & Webb, J. A. W. (2001). Contrast Media Safety Committee of European Society of Urogenital Radiography; Prevention of generalized reactions to contrast media: a consensus report and guidelines. Euro Radiology, 11, 1720-1728.

18.  Panitan, P., Naruemon, D., Kowit, J., Surrerat, J. & Torponf, T. (2013). Adverse Reaction to Iodinated Contrast Media: Prevalence, risk factors and outcome – the result of a 3year period, Asian Pac J Allergy Immunol 31, 299 – 306.

19.  Rawlins, M. D. (1981). Clinical pharmacology: adverse reactions to drugs. BMJ 282974-976.

20.  Shehadi, W. H. (2008). Adverse Reactions to Intravascularly Administered Contrast Media: A Comprehensive Study Based on Prospective Survey. American Journal of Roentgenology, 190, 187-190.

21.  Speck, U., Mutzel. W, & Weinmann, H. J. (1983) Chemistry, Physiochemical and Pharmacology of known and new contrast media for Angiography, Urography and CT-enhancement, fortschr, Rontgenstr. 118, 2-10

22.  Thomsen, H. S. & Morcos, S. K, (2000). Radiographic contrast media, BJU International, 8, 1-10.

23.  Wang, C. L., Cohhan, R. H., James, H. E., Caoili, E. M., Wang, G. & Francis, I. R. (2008). Frequently; Outcome, and appropriateness of Treatment of Non-ionic Iodinated Contrast Media Reactions. American journal of Roentgenology, 409-419.

24.  Wang, D. Y., Forslund, C., Persson, U. & Wiholm, B. E. (1998). Drug-attributed anaphylaxis, Pharmacoepidemiol Drug Safety, 7, 269-74.