Contrast media osmolality

The clinical and biological tolerance of iobitridol (Xenetix, a non-ionic medium, osmolality 915 mosmol/ kg at an iodine concentration of 350 mg/ml) has been assessed in a placebo-controlled study in 21 patients with chronic renal insufficiency (glomerular filtration rate less than 60 ml/minute) (170). Serum creatinine and creatinine clearance remained stable 24 and 48 hours after the procedure. No patient had a nephrotoxic reaction or acute oliguria. Only one patient given iobitridol had an increase in serum creatinine of more than 15% from baseline the serum creatinine normalized within 4 days of contrast administration. One patient given placebo had... 

The use of premedication with steroids and Hi and Hg histamine receptor blockers can significantly reduce the adverse reactions to high osmolality contrast media. There are suggestions to extend their use to modify even the reactions to low osmolality contrast media. Pretesting of contrast media reactors by injecting 1 mL of the nonionic contrast medium has also been reported (539). 

Langner S, Stumpe S, Kirsch M et al (2008) No increased risk for contrast-induced nephropathy after multiple CT perfusion studies of the brain with a nonionic, dimeric, iso-osmolal contrast medium. Am J Neuroradiol 29 1525-1529. 

Nguyen S, Suranyi P, Ravenel J, Randall P, Romano P, Strom K, Costello P, Schoepf U. Iso-osmolality versus low-osmolality iodin-ated contrast medium at intravenous contrast-enhanced CT effect on kidney function. Radiology 2008 248 97-105. 

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