What is visipaque. Visipaque: Uses, Side Effects, and Essential Information for Patients

10.12.197225.08.2021 by alexxlab

What is Visipaque used for. How is Visipaque administered. What are the potential side effects of Visipaque. Is Visipaque safe during pregnancy and breastfeeding. How should Visipaque be stored. What precautions should be taken when using Visipaque. How does Visipaque work in diagnostic imaging.

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Understanding Visipaque: A Comprehensive Guide to This Diagnostic Imaging Agent

Visipaque, also known by its generic name iodixanol, is a widely used contrast medium in diagnostic imaging procedures. This article delves into the various aspects of Visipaque, including its uses, administration, side effects, and important considerations for patients and healthcare providers.

The Role of Visipaque in Medical Imaging

Visipaque plays a crucial role in enhancing the visibility of internal structures during various diagnostic imaging procedures. Its primary function is to improve the contrast of images, allowing healthcare professionals to obtain clearer and more detailed views of organs, blood vessels, and other bodily structures.

Common Diagnostic Procedures Using Visipaque

Angiocardiography
Peripheral arteriography
Visceral arteriography
Cerebral arteriography
Contrast-enhanced computed tomography (CT) of the head and body
Excretory urography
Venography

In addition to these procedures, Visipaque is also utilized in digital subtraction angiography (DSA) and conventional radiography. For pediatric patients, it is indicated for cardioangiography, urography, CT enhancement, and studies of the upper gastrointestinal tract.

Administration and Dosage of Visipaque

Visipaque is administered intravenously through a needle or catheter inserted into a vein. The dosage and administration method may vary depending on the specific diagnostic procedure and the patient’s individual characteristics.

How is the proper dosage of Visipaque determined. Healthcare providers consider several factors when determining the appropriate dosage, including:

The type of diagnostic procedure being performed
The patient’s age, weight, and overall health status
The specific area of the body being examined
Any previous reactions to contrast media

It is crucial for patients to follow their healthcare provider’s instructions carefully and inform them of any allergies or medical conditions before receiving Visipaque.

Potential Side Effects and Adverse Reactions

While Visipaque is generally considered safe when used as directed, like all medications, it can cause side effects in some individuals. It’s important for patients and healthcare providers to be aware of potential adverse reactions.

Common Side Effects

What are the most frequently reported side effects of Visipaque. Some common side effects include:

Discomfort at the injection site (reported in 1-10% of patients)
Headache
Nausea
Dizziness
Taste disturbances (dysgeusia, reported in about 4% of patients)
Skin reactions such as itching (pruritus, reported in about 2% of patients) and rash

Serious Adverse Reactions

While rare, more serious adverse reactions can occur. These may include:

Cardiovascular issues: Cardiac arrest, palpitations, coronary artery spasms, hypertension
Endocrine disorders: Thyroid function changes, including hypothyroidism or transient thyroid suppression
Immune system reactions: Hypersensitivity reactions, including anaphylactic shock (which can be life-threatening)
Neurological effects: Tremors, disturbances in consciousness, transient contrast-induced encephalopathy
Respiratory problems: Cough, throat irritation, laryngeal edema, bronchospasm
Severe skin reactions: In rare cases, conditions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, or drug reaction with eosinophilia and systemic symptoms (DRESS) may occur

Patients should seek immediate medical attention if they experience any severe or concerning symptoms after receiving Visipaque.

Precautions and Contraindications

Before administering Visipaque, healthcare providers must carefully evaluate the patient’s medical history and current health status to ensure its safe use.

Important Considerations

What factors should be taken into account before using Visipaque. Healthcare providers should consider:

History of allergies or previous reactions to iodinated contrast media
Kidney function, as patients with impaired renal function may be at higher risk for adverse effects
Thyroid disorders, particularly in patients with hyperthyroidism or goiter
Cardiac conditions, especially in patients with heart failure or severe arrhythmias
Diabetes, as there may be a risk of lactic acidosis in patients taking metformin
Pregnancy and breastfeeding status

In some cases, the benefits of using Visipaque may outweigh the potential risks, but this decision should be made on a case-by-case basis by qualified healthcare professionals.

Visipaque in Special Populations

The use of Visipaque requires special consideration in certain patient groups, including pregnant women, nursing mothers, and pediatric patients.

Pregnancy and Breastfeeding

Is Visipaque safe for use during pregnancy and breastfeeding? The safety of Visipaque in pregnant women has not been conclusively established. It should only be used during pregnancy if the potential benefits justify the potential risks to the fetus. For breastfeeding mothers, it is recommended to discontinue breastfeeding for 24 hours after receiving Visipaque, as iodinated contrast media can be excreted in breast milk.

Pediatric Use

Visipaque is approved for use in pediatric patients for specific procedures, including cardioangiography and urography. However, dosing and administration should be carefully adjusted based on the child’s age, weight, and the specific diagnostic procedure being performed.

Storage and Handling of Visipaque

Proper storage and handling of Visipaque are essential to maintain its efficacy and safety. Healthcare facilities and pharmacies must adhere to specific guidelines to ensure the integrity of the product.

Storage Conditions

How should Visipaque be stored? The following storage conditions should be observed:

Store below 30 degrees Celsius (86 degrees Fahrenheit)
Do not freeze
Protect from light
Observe the shelf life, which is typically 2-3 years from the date of manufacture

It’s crucial to inspect the solution visually before use. Visipaque should appear as a clear to practically clear, colorless to slightly yellow solution. Any changes in color or the presence of particulate matter may indicate that the product should not be used.

The Science Behind Visipaque: How It Works

Understanding the mechanism of action of Visipaque can help healthcare providers and patients appreciate its role in diagnostic imaging.

Iodixanol: The Active Ingredient

Visipaque’s active ingredient, iodixanol, is a non-ionic, dimeric contrast medium. Its molecular structure contains iodine atoms, which are responsible for its contrast-enhancing properties.

How does iodixanol enhance image contrast? When introduced into the body, iodixanol:

Absorbs X-rays more effectively than surrounding tissues
Creates a density difference between the contrast-filled areas and the surrounding structures
Allows for better visualization of blood vessels, organs, and other anatomical structures

The non-ionic nature of iodixanol contributes to its lower osmolality compared to some other contrast media, which may result in fewer adverse reactions in some patients.

Pharmacokinetics and Excretion

After administration, Visipaque is distributed throughout the extracellular fluid space. It does not undergo significant metabolism and is primarily excreted unchanged through the kidneys. This renal excretion makes Visipaque particularly useful for urographic procedures and allows for its eventual elimination from the body.

What is the typical timeline for Visipaque excretion? In patients with normal renal function:

Approximately 97% of the administered dose is excreted within 24 hours
Less than 2% is eliminated after 3 days

This rapid excretion profile contributes to the overall safety profile of Visipaque when used as directed.

Visipaque in Clinical Practice: Optimizing Diagnostic Outcomes

The effective use of Visipaque in clinical practice involves more than just administration of the contrast medium. Healthcare providers must consider various factors to optimize diagnostic outcomes and patient safety.

Preprocedural Considerations

What steps should be taken before administering Visipaque? Healthcare providers should:

Conduct a thorough patient history review, focusing on allergies and previous reactions to contrast media
Assess the patient’s hydration status and encourage adequate fluid intake before the procedure
Consider prophylactic measures for high-risk patients, such as those with a history of moderate to severe contrast reactions
Ensure that emergency equipment and medications are readily available in case of adverse reactions

During the Procedure

Careful monitoring during the administration of Visipaque is crucial. Healthcare providers should:

Use the lowest effective dose of contrast medium necessary for diagnostic accuracy
Monitor the patient for signs of immediate adverse reactions
Be prepared to adjust the procedure or intervene if complications arise

Post-Procedure Care

After the diagnostic imaging procedure, patients should be monitored for a period of time to ensure no delayed reactions occur. Instructions for post-procedure care may include:

Increasing fluid intake to help eliminate the contrast medium
Watching for signs of allergic reactions or other adverse effects
Following up with healthcare providers as directed

By following these best practices, healthcare providers can maximize the diagnostic value of Visipaque while minimizing potential risks to patients.

Future Developments and Research in Contrast Media

As medical imaging technology continues to advance, research into contrast media like Visipaque remains an active field of study. Scientists and healthcare professionals are constantly seeking ways to improve the safety, efficacy, and versatility of contrast agents.

Emerging Trends in Contrast Media Research

What are some of the current areas of focus in contrast media research? Ongoing studies are exploring:

Development of contrast agents with even lower osmolality to further reduce the risk of adverse reactions
Creation of targeted contrast agents that can highlight specific tissues or pathologies
Investigation of alternatives to iodine-based contrast media for patients with iodine allergies or renal impairment
Exploration of dual-energy CT techniques that may allow for reduced contrast medium doses
Integration of artificial intelligence to optimize contrast media use and image interpretation

These advancements may lead to more personalized and efficient use of contrast media in the future, potentially improving diagnostic accuracy while minimizing patient risk.

The Role of Visipaque in Evolving Imaging Technologies

As imaging technologies continue to evolve, the role of contrast media like Visipaque may also change. For example:

Advanced CT and MRI techniques may require new formulations or administration protocols for optimal results
Molecular imaging approaches may incorporate contrast agents with specific targeting capabilities
The integration of imaging with other diagnostic modalities may lead to new applications for contrast enhancement

Staying informed about these developments is crucial for healthcare providers to ensure they are providing the most up-to-date and effective diagnostic services to their patients.

Patient Education and Informed Consent

Effective communication between healthcare providers and patients is essential when using contrast media like Visipaque. Proper patient education and informed consent can help alleviate anxiety, improve compliance, and ensure better overall outcomes.

Key Points for Patient Education

What information should be conveyed to patients before administering Visipaque? Healthcare providers should discuss:

The purpose of the contrast medium and its role in the diagnostic procedure
Potential risks and benefits of using Visipaque
Common side effects and what to do if they occur
The importance of disclosing any allergies or medical conditions
Instructions for before, during, and after the procedure
Signs and symptoms that should prompt immediate medical attention

Obtaining Informed Consent

The process of obtaining informed consent should be thorough and documented. It should include:

A clear explanation of the procedure and the use of Visipaque
Discussion of alternative options, if available
Opportunity for the patient to ask questions and express concerns
Documentation of the patient’s understanding and agreement to proceed

By prioritizing patient education and informed consent, healthcare providers can foster a collaborative approach to diagnostic imaging and enhance patient satisfaction and safety.

Visipaque (iodixanol) dosing, indications, interactions, adverse effects, and more

>10%

Discomfort at injection site (

1-10%

Angina pectorin (

Chest pain (

Headache (

Migraine (

Vertigo (

Parethesia (1%)

Pruritus (2%)

Skin rash (

Erythema (

Dysguesia (4%)

Postmarketing Reports

Cardiovascular Disorders: Cardiac arrest, palpitations, spasms of coronary arteries, hypertension, and flushing

Endocrine Disorders: Thyroid function tests indicative of hypothyroidism or transient thyroid suppression have been uncommonly reported following iodinated contrast media administration to adult and pediatric patients, including infants; some patients were treated for hypothyroidism; hypoglycemia, hyperthyroidism

Eye Disorders: Transient visual impairment including cortical blindness, diplopia, and blurred vision

Gastrointestinal Disorders: Abdominal pain, pancreatitis, salivary gland enlargement

General Disorders and Administration Site Conditions: Chills, pyrexia, pain and discomfort, administration site reactions including extravasation

Immune System Disorders: Hypersensitivity reactions, anaphylactic shock including, life-threatening or fatal anaphylaxis

Nervous System Disorders: Tremor (transient), coma, disturbance in consciousness, transient contrast-induced encephalopathy caused by extravasation of contrast media (including amnesia, hallucination, paralysis, paresis, transient speech disorder, aphasia, dysarthria)

Psychiatric Disorders: Anxiety, agitation

Respiratory, Thoracic, and Mediastinal Disorders: Cough, sneezing, throat irritation or tightness, laryngeal edema, pharyngeal edema, bronchospasm

Skin and subcutaneous tissue disorders: Reactions range from mild (e. g. rash, erythema, pruritus, urticaria, and skin discoloration) to severe: [e.g. Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematous pustulosis (AGEP) and drug reaction with eosinophilia and systemic symptoms (DRESS)]

Visipaque | healthdirect

What it is used for

This medicinal product is for diagnostic use only. Visipaque is indicated in adult patients for angiocardiography, peripheral arteriography, visceral arteriography, cerebral arteriography, contrast-enhanced computed tomography of the head and body, excretory urography and venography. In arteriography, Visipaque may be used for both conventional radiography and digital subtraction angiography (DSA). In children, Visipaque is indicated for cardioangiography, urography, CT enhancement and studies of the upper gastrointestinal tract.

How to take it

The way to take this medicine is: Intravenous.
This medicine or fluids is given through a needle or tube (catheter) inserted into a vein.

Store below 30 degrees Celsius
Do not Freeze
Protect from Light
Shelf lifetime is 2 Years.
Store below 30 degrees Celsius
Do not Freeze
Protect from Light
Shelf lifetime is 3 Years.

You should seek medical advice in relation to medicines and use only as directed by a healthcare professional.

Always read the label. If symptoms persist see your healthcare professional.

Visual appearance

A clear to practically clear, colourless to slightly yellow solution

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Iodinated contrast agents are usually classified based upon their osmolality—high, low, and isosmolar. Iodinated contrast agents are also nephrotoxic in some but not all patients resulting in loss of glomerular filtration rate. Over the past 30 years, nephrotoxicity has been linked to osmolality although the precise mechanism underlying such a link has been elusive. Improvements in our understanding of the pathogenesis of nephrotoxicity and prospective randomized clinical trials have attempted to further explore the relationship between osmolality and nephrotoxicity. In this review, the basis for our current understanding that there are little if any differences in nephrotoxic potential between low and isosmolar contrast media will be detailed using data from clinical studies.

Radiographic contrast agents have been in use for over 60 years. Based upon current data, 2.0 million cardiac catheterizations are performed annually in the USA [1] and nearly 30 million contrast-enhanced CT scans, in addition to the use of contrast for peripheral angiography. An average contrast-enhanced CT uses ~40 grams of iodine chemically bound to an organic molecule that is injected directly into the vascular system. This is a very large dose of foreign material and speaks to the overall safety of these agents.

In the mid-1950s, it was recognized that some patients develop a rise in serum creatinine (the definition of contrast-induced acute kidney injury or CIAKI) following the administration of high-osmolar contrast media. Most of these patients received intra-arterial infusions, for example, for coronary angiography. The development of CIAKI has been widely documented in the literature and the risk factors for developing such an injury are exhaustively described [2]. It should be noted that these were observational retrospective studies and no control groups were assessed. Furthermore, no adjudication for other potential causes of a rise in serum creatinine was provided. Nevertheless, animal studies and in vitro studies with lines of kidney cells have provided the basis for the conclusion that contrast media can cause kidney injury. We have come to know much about the pathogenesis of this injury; it involves direct tubule cell nephrotoxicity as well as ischemia mediated by decreased availability of NO and the generation of reactive oxygen species particularly in the medulla of the kidney [3]. In this review, the relevance of the physical properties of the contrast media—ionicity, osmolality, and viscosity—to the development of CIAKI will be reviewed.

As noted above, the size and number of organic molecules binding the iodine are the primary determinant of the ionicity, osmolality, and viscosity of the commercial product. Over the past 2 decades, we have moved in the development of contrast media from ionic monomers through nonionic monomers to nonionic dimers increasing the number of iodine atoms per molecule from 1.5 to 6.0 (see Figure 1). These changes have resulted in less total molecules (lower osmolality) necessary to deliver a sufficient amount of iodine for adequate imaging but progressively larger molecules (more viscosity) (see Table 1).


	Concentration (mgl/mL)	Grams of iodine/100 mL	Osmolality (mmol/Kg at 37°C)	Viscosity (cP at 37°C)

Iodixanol (Visipaque)	270–320	27–32	290	6.3–11.8
Iohexol (Omnipaque)	140–350	14–35	322–844	1.5–10.4
Iopamidol (Isovue)	200–370	20–37	413–796	2.0–9.4
Iopromide (Ultravist)	150–370	15–37	328–774	1.5–10.0
Ioversol (Optiray)	160–350	16–35	355–792	1.9–9.0

In general, the higher the osmolality of the contrast media, the greater the urine output in the first few hours following their administration. This makes sense physiologically as the contrast medium is a nonreabsorbable solute which acts like an osmotic diuretic, reducing electrolyte reabsorption along the nephron and obligating an increase in urine output. An increase in urine output has been observed when comparing high and low-osmolality contrast media as well as low and isoosmolality contrast media [4].

A definite increase in urine viscosity is observed when using contrast medium that is of very large molecular size (e.g., nonionic dimers). This occurs as a result of the progressive concentration of the contrast medium as it travels down the nephron and 99% of the filtered water is reabsorbed. Urine viscosity can be directly measured and increases significantly only with isosmolar contrast media [4, 5].

The osmotic diuresis with high- and low-osmolality contrast media could result in extracellular volume contraction, stimulation of the intrarenal renin-angiotensin-aldosterone axis, and/or release of other vasoconstrictor hormones (endothelin or adenosine, e.g.) that would augment the direct vasoconstrictor effects of contrast media and further exacerbate ischemia. The increase in urine viscosity could raise the pressure within the tubule lumen and reduce the net driving force for glomerular filtration (capillary hydrostatic pressure—(pressure within tubule + plasma oncotic pressure)) and thus directly decrease GFR. The degree to which these predictable effects contribute to the development of CIAKI will depend upon the amount of contrast medium administered and the unique physiologic environment of each patient. For example, the number of nephrons filtering the contrast media (reduced in chronic kidney disease) and the degree of reabsorption within the nephron (stimulated in extracellular volume depletion and congestive heart failure) might be expected to interact with these physiologic effects. As an example, when there is more reabsorption of filtrate because of volume depletion or heart failure, the viscosity in the urine following administration of a nonionic dimer would be greater. Similarly, if a patient is already volume depleted and receives a high-osmolality agent with subsequent increase in urine output, extracellular volume depletion would be exacerbated resulting in a greater stimulation of intrarenal vasoconstrictor factors.

To date, the vast majority of clinical trials have used serum creatinine, a marker of glomerular filtration rate, to define CIAKI. The underlying assumption is that with injury to the tubules, there is a reduction in GFR mediated by a variety of mechanisms within the kidney. However, there are many problems with using creatinine as a measure of an acute change in GFR including the following.(i)Creatinine is not an ideal marker of GFR because it undergoes secretion and even reabsorption. Changes in serum creatinine could therefore reflect changes in secretion and/or reabsorption without a change in glomerular filtration [6].(ii)There is a lag phase of 1-2 days before creatinine will rise sufficiently to meet the threshold for CIAKI even when GFR is severely affected. This is because the retained creatinine must distribute in total body water resulting in a slow rise in serum levels. Because of the time lag, an acute reduction in GFR can be missed if serial creatinine levels are not determined for at least 72 hours [7].(iii)A true change in GFR might occur as a result of hemodynamic changes without any evidence of tubule injury. In this circumstance, an increase in serum creatinine sufficient to define CIAKI would not be associated with true injury.(iv)Likewise, tubule injury may not always be reflected in a change in GFR. In this circumstance, injury would be missed by reliance on serum creatinine [8].

In the 1980–1990s, the development of nonionic contrast media (low-osmolality contrast medium, ratio: 3 iodines per molecule) was quickly adopted because of a decrease in nonkidney side effects. In particular, the feelings of warmth, nausea, and itching were all diminished with low-osmolality contrast media (LOCM) compared to high-osmolality contrast media (HOCM). Many randomized controlled trials were performed to evaluate whether LOCM reduced the incidence of nephrotoxicity compared to HOCM. An important milestone was the meta-analysis of these trials performed by Barrett and Carlisle in 1993 [9]. These authors indeed found a reduction in the incidence of CIAKI with the use of a low- compared to the high-osmolality contrast media. However, a more in-depth review of their publication reveals the following.(i)There was no difference in the incidence of CIAKI in patients who had normal kidney function.(ii)There was a 50% reduction in the incidence of CIAKI only in patients with an initial creatinine clearance less than 60 mL/min.(iii)The reduction in the incidence of CIAKI was seen only when the contrast was given intra-arterially but not intravenously.

In the late 1990s, a new class of contrast agent—isosmolar or IOCM—came into clinical use. Based upon the meta-analysis of Barrett and Carlisle that found that osmolality contributed to the nephrotoxicity of contrast media under certain circumstances, it was quite reasonable to hypothesize that the IOCM would be associated with less CIAKI compared to LOCM. A seminal study supporting this claim was the NEPHRIC trial. This was a 129-patient, randomized trial in patients with diabetes and chronic kidney disease (estimated creatinine clearance <60 mL/min) who were undergoing cardiac angiography [10]. The IOCM (iodixanol, Visipaque) was compared to a LOCM (iohexol, Omnipaque) with the primary endpoint of CIAKI defined as a >0.5 mg/dL absolute rise in creatinine over 48–72 hours. The incidence of CIAKI with iodixanol was significantly lower than with iohexol (2% versus 16%, resp.) in this high-risk population.

What followed the publication of the NEPHRIC trial in the New England Journal of Medicine in 2003 can aptly be described as a “war.” Manufacturers of LOCM other than the one studied in the NEPHRIC trial immediately set to work to replicate or repudiate the finding using their own LOCM. Multiple RCTs were conducted in high-risk populations undergoing cardiac angiography, peripheral angiography, or contrast-enhanced CT. Over the past decade, at least 4 meta-analyses of these trials were published with essentially similar findings [11–14] (see Figures 2(a), 2(b), 2(c), and 2(d)). Some meta-analyses mixed intravenous and intra-arterial administration, while others excluded studies presented in abstract. Most meta-analyses found little evidence of heterogeneity strengthening the conclusions of the analyses. The incidence of CIAKI (by any definition) was similar between LOCM and IOCM with the possible exception of the LOCM, iohexol [12].

Was NEPHRIC just wrong? It is always easy to argue that a study with only 129 subjects and in which the primary endpoint occurs in <10% is going to be underpowered and subject to a type-1 error. This is certainly one possibility. Was NEPHRIC correct but used as a comparator a particular LOCM (iohexol) with a higher with a higher incidence of CIAKI? The subsequent studies using other LOCMs would support this conclusion as well. If one refers to Table 1, iohexol has the highest viscosity of the LOCMs. Perhaps, viscosity and osmolality both contribute to nephrotoxicity (see above). To date, there has not been a randomized controlled trial comparing iohexol to any other LOCM in a high-risk population. The updated 2011 AHA/ACC guidelines for use of contrast media in high-risk patients do not favor IOCM over LOCM [15].

What are the limitations of these studies and the subsequent meta-analyses? These randomized prospective trials all used serum creatinine as the marker of injury. They assumed that any increase in creatinine following contrast exposure was caused by the contrast (no adjudication for other causes of a rise in serum creatinine). Katzberg et al. noted persistent global and focal nephrograms on CT performed 24 hours following administration of isosmolar contrast for coronary angiography [17]. Such findings might be explained by microemboli rather than contrast-induced nephrotoxicity. Unfortunately, the study did not measure either serum creatinine or injury markers raising the possibility that the findings are simply a paraphenomenon. Indeed others have noted similar persistent nephrograms following isosmolar contrast and suggested that increased viscosity of isosmolar contrast leads to longer retention times within the kidney [18]. Regardless of mechanism, the findings do not exclude the possibility of direct nephrotoxicity from contrast.

What about differences between contrast media when given by the intravenous route? There is a significant body of literature suggesting an overall lower incidence of nephrotoxicity when iodinated contrast is given intravenously compared to intraarterially [19]. The basis for this difference in nephrotoxicity is multifactorial and includes the following:(i)differences in chronic comorbidities between those getting IV versus IA contrast media,(ii)differences in dose of contrast administered,(iii)ascertainment bias resulting from different follow-up protocols in those receiving IA versus IV contrast,(iv)bias resulting from acute hemodynamic instability, more likely in hospitalized versus nonhospitalized patients and thus more likely in IA versus IV contrast administration.

However, it should again be emphasized that the development of a rise in serum creatinine following a contrast-enhanced CT may not reflect kidney injury or specifically injury resulting from contrast (see above regarding limitation of using serum creatinine). Randomized controlled trials using specific injury markers that are known to increase after contrast induced injury. Even with injury markers such as NGAL, IL-18, and KIM-1, there is no specificity for contrast-induced injury.

In addition, a number of authors have found that the incidence of a rise in serum creatinine following a non-contrast-enhanced CT is similar to that following a contrast-enhanced CT, particularly in those without severe reduction in GFR at baseline [20–22]. This suggests that other explanations for a rise in creatinine in these patients should be explored. The most likely explanation would be hemodynamic instability in patients with an indication for a contrast-enhanced CT. Interestingly, a recent abstract found no evidence for an increase in urinary markers of injury (KIM-1 and NGAL) following 511 contrast-enhanced CT exams [23]. In this population, 3.9% developed CIAKI by a usual definition using serum creatinine changes.

A few studies have focused on the thrombogenicity of different contrast agents. In vitro studies have suggested that ionic low-osmolar contrast is less thrombogenic compared to either isosmolar or low-osmolar nonionic contrast [24]. Clinical trials evaluating potential thrombotic complications have focused on MACE (cardiac death, recurrent nonfatal acute MI, and emergency CABG or repeat PCI) or acute and subacute stent restenosis [25, 26]. Both trials reported a significant reduction in the primary endpoints with ionic low-osmolar contrast. These events occur infrequently which leads to concerns about the power of the individual studies. They were also done during an era when anticoagulation protocols were different than current protocols. Finally a number of other studies could not replicate these results so the issue remains unsettled [27–30].

While the meta-analysis data seems clear regarding an absence of differences in nephrotoxicity between IOCM and LOCM, there is relatively little data regarding long-term consequences following contrast administration. Since the contrast is eliminated from the body almost completely within 24 hours, any long-term consequences related to contrast administration are likely related to acute kidney injury at the time of administration, for example, nephrotoxicity or the comorbidities present in patients who developed acute kidney injury. Again, the assumption has been that the acute kidney injury is related to the contrast and not some other mechanism. Many observational studies and retrospective reviews of databases have reported on the association between CIAKI and congestive heart failure, mortality, and the long-term loss of kidney function including the need for dialysis. It is beyond the scope of this review to discuss whether this association represents causality or not. The reader is referred to reviews of this topic [31].

In an observational study by Per Liss and collaborators, the risk of readmission to the hospital with a diagnosis of acute kidney injury within 1 year following the exposure to an isosmolar or low-osmolar contrast media is described using data from the Swedish Cardiovascular Registry [32]. The Swedish hospital system mandates use of only one contrast agent in each hospital. These authors found a higher incidence of acute kidney injury readmission in hospitals using an IOCM compared to any LOCM. Furthermore, in hospitals that switched from IOCM to LOCM during the years of the study, the incidence of acute kidney injury decreased. Since this is an observational database and not a randomized trial, the results should be taken with caution. However, the uniqueness of the Swedish system eliminates many sources of bias inherent in other observational databases.

The CARE follow-up trial followed patients for one year who were enrolled in a prospective randomized trial comparing iopamidol (low-osmolar contrast media) to iodixanol (isosmolar contrast media) [16]. Prespecified endpoints included death, stroke, myocardial infarction, end-stage kidney disease, percutaneous coronary revascularization, coronary artery bypass graft surgery, other revascularization procedures (e.g., carotid, runoff vessels), and others (e.g., cardiac arrest, development of congestive heart failure or pulmonary edema, and need for permanent pacing). Four events were considered major adverse events: death, stroke, myocardial infarction, and ESRD. When more than one event occurred in the same patient, only the first event was used for analysis. In this study, CIAKI was defined using a number of novel markers: an absolute increase in serum creatinine of 0.3 mg/dL and a 15%, 20%, or 25% increase in serum Cystatin C (to avoid some of the problems mentioned above regarding creatinine). All of these novel definitions were associated with a 2-fold increase in the incidence of adverse events. There were no differences in baseline risk factors, demographics, or procedural characteristics between the two groups. At one year, there was a statistically significant difference in all adverse events and major adverse events in favor of iopamidol. This reduction in adverse events was associated with a reduction in the incidence of CIAKI in the iopamidol group using any of the novel AKI markers.

Contrast media are extremely safe but can precipitate acute kidney injury in a small number of high-risk patients. Based upon randomized trial data, there do not appear to be significant differences in the nephrotoxicity between contrast media that differ on the basis of ionicity, osmolality, or viscosity. This conclusion applies to both the intravenous and intra-arterial administration of contrast. Although a few trials have described long-term differences in outcomes based on viscosity and osmolality, further studies are clearly needed to define potential mechanisms and to confirm these preliminary findings.

Reproduction studies were performed in rats and rabbits with intravenous administration of iodixanol at doses up to 2 g Iodine/kg, daily, from implantation of the embryo (gestation day 7 in rat; 6 in rabbit) through closure of the hard palate (gestation day 17 in rats; 18 in rabbits). No maternal toxicity occurred, and no adverse effects occurred on fetal survival, embryo-fetal development, or the ability of dams to rear a litter.

There are no data on the presence of iodixanol in human milk, the effects on the breastfed infant or the effects on milk production. Iodinated contrast agents are poorly excreted into human milk and are poorly absorbed by the gastrointestinal tract of a breastfed infant. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for VISIPAQUE and any potential adverse effects on the breastfed infant from VISIPAQUE or from the underlying maternal condition.

Interruption of breastfeeding after exposure to iodinated contrast agents is not necessary because the potential exposure of the breastfed infant to iodine is small. However, a lactating woman may consider interrupting breastfeeding and pumping and discarding breast milk for 10 hours (approximately 5 elimination half-lives) after VISIPAQUE administration in order to minimize drug exposure to a breast fed infant.

The safety and efficacy of VISIPAQUE have been established in pediatric patients down to birth for angiocardiography, cerebral arteriography, visceral arteriography, CT imaging of the head and body, and excretory urography. The safety and efficacy of VISIPAQUE have also been established in pediatric patients 12 years and older for intra-arterial digital subtraction angiography, peripheral arteriography, peripheral venography and CCTA. Use of VISIPAQUE is supported by evidence from adequate and well controlled studies of VISIPAQUE in adults and additional safety data obtained in 459 pediatric patients. In general, the types of adverse reactions reported are similar to those of adults. A higher number of adverse events in patients less than 1 year of age compared to older patients were observed in a study of VISIPAQUE [see Adverse Events (6.3)]. The elimination of VISIPAQUE is slower in this age group [see Clinical Pharmacology (12.3)].

Pediatric patients at higher risk of experiencing an adverse reaction during and after administration of any contrast agent may include those with asthma, hypersensitivity to other medication and/or allergens, cyanotic and acyanotic heart disease, congestive heart failure, or a serum creatinine greater than 1.5 mg/dL. Pediatric patients with immature renal function or dehydration may be at increased risk for adverse events due to slower elimination of iodinated contrast agents [see Clinical Pharmacology (12.3)].

In clinical studies of VISIPAQUE, 254/757 (34%) of patients were 65 and over. No overall differences in safety or effectiveness were observed between these patients and younger patients. Other reported clinical experience has not identified differences in response between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. In general, dose selection for an elderly patient should be cautious usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.

Usually, VISIPAQUE does not cause any serious side effects. It can, however, sometimes cause unwanted effects in some people. All medicines can have side effects. You may need medical treatment if you get some of the side effects during or after the procedure. Although there is a risk that you might get an unwanted effect, your doctor will have chosen this contrast medium by considering these risks and the benefits of the examination.

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IVC agents are a regulated drug class, and can be only administered by prescription, just like any other controlled medication, this is why the use of IV contrast must be specified or indicated by the physician ordering the examination. The radiology department may alter the prescribed use of IV contrast per department protocol, radiologist orders, or by other safety concerns, but the initial request for the use of IVC must come from the physician ordering the examination.

A prime example of this would be in a patient undergoing an MRI of the lumbar spine, where the patient has had a prior history of back surgery or current history of a suspected soft tissue mass. In both cases, the need to differentiate between normal, healthy tissue and that of old scar tissue or neoplasm would indicate the use of MR IVC. If the patient has neither history of suspected mass, nor a history of prior surgery in the region of interest, then MR IVC would not be indicated.

For CT scan, IVC is composed of an organically bound iodine / benzene compound in a saline solution, and are designed to make blood and organs more radio-opaque by absorbing a small percentage of X-rays that would normally pass through the body. CT scan images are projected in thousands of shades of gray, whereas the human brain can only discern between 40 and 100 shades. IVC changes the density of tissues, and therefore the perceived image is rendered in what looks to be a more “black and white” image. With increased contrast comes increased visualization between adjacent structures observed in a CT scan image.

Overdose is unlikely in patients with normal renal function.Long-term treatment at high doses of the drug may affect renal function (half-life – 2 hours). In case of accidental overdose, it is necessary to correct the violation of the water-electrolyte balance using infusion therapy. The next 3 days should be monitored for kidney function. If necessary, the excess of the drug is removed by hemodialysis. There is no specific antidote. In case of an overdose, symptomatic therapy is used.

Adverse reactions, predetermined by the use of Visipak, usually have a mild and moderate degree of clinical manifestation, as well as a reversible nature. Serious reactions and fatal consequences are rare. They may include: acute chronic renal failure, acute renal failure, anaphylactic or anaphylactoid shock, hypersensitivity reactions that are accompanied by reactions from the heart (acute coronary syndrome), cardiac arrest, cardiac and respiratory arrest, myocardial infarction.

Hypersensitivity reactions can occur, which usually manifest themselves in the form of respiratory and skin reactions such as shortness of breath, rash, erythema, spraying, pruritus, severe skin reactions, angioedema, arterial hypotension, fever, laryngeal edema, bronchospasm and pulmonary edema. In patients with autoimmune diseases, cases of vasculitis and signs of Stevens-Johnson syndrome were observed.They can develop both immediately after the administration of the drug, and after a few days. Hypersensitivity reactions can occur regardless of the dose and route of administration. Mild symptoms may be the first signs of a severe anaphylactic reaction / shock.

Adverse reactions are distant and may occur after a few hours or days after intrathecal administration. Their frequency approximately corresponds to the frequency of complications after lumbar puncture without the introduction of contrast medium. When using other non-ionic contrast agents, signs of irritation of the meninges may appear in the form of photophobia, meningism, chemical meningitis. You should also keep in mind the possibility of infectious meningitis.

Iodixanol is an injection contrast agent that can be used in tapered tube angiography, cardiocerebral angiography and intravenous urography. It works by combining iodine to absorb X-rays in blood vessels or tissues to cause an image to be displayed. The effect of iodixanol on cardiovascular parameters and femoral blood flow is less, but it should be paid attention to in elderly patients with renal failure who have undergone coronary intervention.

Iodixanol injection had little effect on renal function.For diabetic patients with serum creatinine levels between 1.3 and 3.5 mg / dL, only 3% of patients have increased creatinine levels greater than or equal to 0.5 mg / dL, but no increase in creatinine levels will be greater than or equal to 1.0 mg / dl. The amount of enzymes (alkaline phosphatase and N-acetyl-beta-glucosaminidase) released from adjacent tubular cells was less than the amount of enzymes administered with non-ionic monomeric contrast media and showed the same trend as ionic monomeric contrast media.Iodixanol injection is also well tolerated by the kidneys.

The scientific and educational program of the congress included individual sessions and master classes, interactive training lectures on new directions in radiology. A special feature of the current forum was the session on visualization and performing interventions on the spinal cord using the methods of imaging the heart and mammary gland. The congress also highlighted new advances in computed tomography (CT) and magnetic resonance imaging (MRI) for trauma, as well as ways to visualize joints.

– Radiation diagnostics is heavily dependent on technological innovation. Currently, all methods of radiological diagnostics are digital; methods of three-dimensional imaging have become widespread.Thanks to the new capabilities of CT and MRI, they began to be used as screening techniques for detecting violations at the preclinical stage. Thus, CT angiography allows obtaining high-resolution images of blood vessels up to images of coronary arteries and coronary artery bypass grafts. CT angiopulmonography has become the leading method for the diagnosis of pulmonary embolism. With the help of CT, it is possible to identify and characterize pathological foci in organs, and the volumetric image allows you to study perfusion and microcirculation in them, which is especially important for the diagnosis of diseases of the brain and heart.

Despite all these advantages, patients are still suspicious of radiation research methods, especially those requiring the administration of contrast agents. Among the reasons for such fears are reluctance to receive radiation exposure, fear of a foreign chemical introduced into the body (contrast), and the likelihood of side effects. Indeed, improper use of contrast agents is associated with significant complications, especially from the kidneys, heart, and also directly examined organs.It is extremely important to choose the right contrast agent that meets all the requirements; the tolerance of the contrast agent and its ability to provide the required level of contrast should be taken into account. CT contrast medium should not adversely affect renal function in high-risk patients and tissue damage in the event of extravasation, nor should it cause patient discomfort when administered.

Recently, indications for radiological studies have expanded significantly.The proportion of high-risk patients has increased: these are elderly people, patients with diabetes mellitus (DM) and chronic kidney disease; in clinical practice, non-steroidal anti-inflammatory drugs, ACE inhibitors, diuretics, etc. are widely used, which is also a risk factor for the development of such complications as contrast-induced nephropathy.

– CT has the highest radiation load among all radiological research methods. The use of contrast in this case is associated with the risk of developing another complication – contrast-induced nephropathy, which is the third most frequent cause of the development of renal failure in the hospital [3].The risk of this complication among patients with already reduced renal function, the presence of diabetes mellitus, dehydration, congestive heart failure, and also when taking nephrotoxic drugs can reach 50%.

Before carrying out the procedure, it is necessary to carefully select patients, and in patients with the listed risk factors, take preventive measures. According to the recommendations of the European Society of Urogenital Radiology, today, the measure of prevention of the development of contrast-induced nephropathy is the hydration of patients before and after the administration of a contrast agent.However, it is also important to understand that often the benefits of doing research far outweigh the risk of side effects. Thanks to contrast imaging, many dangerous diseases, including cancer, can be detected in the early stages.

In the study by Shaun A. Nguyen et al. [5] studied the effect of iso-osmolar contrast agent iodixanol and low-osmolar iopromide on renal function (assessed serum creatinine level and glomerular filtration rate) in high-risk patients during CT. When evaluating the results, it turned out that the serum creatinine level in the iodixanol isoosmolar contrast agent group was lower than in the iopromide group. Thus, in this study, according to the authors, the use of iodixanol did not increase the incidence of renal side effects in the high-risk group of patients.

– The advent of multislice computed tomography (MSCT), initially with four-row detectors, and its widespread introduction into clinical practice has opened up new possibilities for non-invasive imaging of the heart, in particular for diagnostic studies of coronary arteries. Many studies demonstrate the possibility of using MSCT in the diagnosis of coronary heart disease, especially among low-risk patients with a reduced heart rate (HR).The advantages of MSCT are associated with improved spatial and temporal resolution in combination with ECG synchronization of the data obtained. Further development of the technology made it possible to achieve a narrower collimation and slice thickness in the submillimeter range, as well as an increase in the rotation speed. This resulted in a steady improvement in spatial and temporal resolution, while wider detectors provided coverage of larger areas. However, step-by-step scanning with prospective ECG synchronization does not provide the possibility of multisegment reconstruction at high heart rate.At a low heart rate with a normal rhythm, good image quality is provided, but at a high heart rate and arrhythmia, artifacts are likely to appear, which lead to “blurring” of the vascular contours due to the difference in the degree and rate of deviation of the coronary artery.

Post-hospital pneumonia (PP) is a type of hospitalization, which is characterized by lesions of parenchymal diseases and swelling in a community, so that the posture of a medicalPP є we are widely expanding and potentially serious ailments, as they associate with high mortality, especially in the middle of the lithuanian, curtsy people, people from fellow patients and immunodepression. Clinical manifestations of PP are variable: from an easy interruption with a feverish and productive cough to distress and sepsis. PP is a part of differential diagnostics of practically all respiratory illnesses, as well as one of the main causes of illness and mortality in the world. Timely diagnostics, assigned to the regime of treatment and an innocent ear of antibiotic therapy (ABT) є key lanks to the management of the PP.In materials, the principle of PP management in outpatient minds is based on the recommendations published in UpToDate. Writing material based on statti Julio A. Ramirez and spivavt. “Overview of community-acquired pneumonia in adults”, published 13 March 2020
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2006 for the American College of Pulmonary Medicine (ACCP), in the presence of upper dysfunctional cough syndrome (SCVDS), earlier – postnasal obstruction syndrome (SPNZ), which is one of the most pathogenic pathogens in chronic cough (HC).The ailments on the SPSH have a cough due to the use of the VDSH, a deep congestion of the nose and sinuses. There can also be a lot of anatomical symptoms, rhinitis of physical or chemical etiology, as well as throat pain [4-6]. …

The cause of severe severe respiratory syndrome – SARS-CoV-2 – became the cause of the new pandemic, so it was bare on the cob in 2020.In the breast of 2019, the rock has been registered for the decay of the COVID-19 virus, but for the last few years it has grown rapidly and inevitably. The mechanism of transmission of SARS-CoV-2-infection is also a bit-droplet. Inflammation is also possible when in contact with contaminated surfaces. The key to the employees in the fight against COVID-19 is to reduce the transmission of the virus, as well as to reduce the intake of antiseptics, as it is possible to vikoristovuvati both in medicine and in the booth. In the presented pre-adolescent vivchali wasted povidone-iodine (PVP-I) as an antiseptic (in concentrations from 1 to 5%), which has a virulicidal activity against the COVID-19 pathogen, for rinsing the nasal and oral pores….

Chronic obstructive disease of the leg (COPD) is a price for anyone who can get it and who can get it.Vin is characterized by persistent respiratory symptoms and a strong fiery reaction to small particles and gases. Uninvolved for those COPDs, they often associate with other chronic ailments, with emphysema and bronchitis; The increase in the frequency of severe COPD aggravations is associated with the reduction of the results of the vision. On COPD there are 8-10% of the overgrown population of the country due to a high income and 15-20% of chickens.All-day organizing of health predictions, as well as not living through life important visits to change the main factors of the risk, good health and well-being in the future, due to the third reason until 2030
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