Frequency and Severity of Acute Adverse Effects of Low Osmolar Iodinated Contrast Media in Contrast-Enhanced Computed Tomography

Journal of Health and Medical Sciences

ISSN 2622-7258

Published: 25 March 2019

Frequency and Severity of Acute Adverse Effects of Low Osmolar Iodinated Contrast Media in Contrast-Enhanced Computed Tomography

Nadiya Abdul Karim, Kashif Shahzad, Rafia Ibrar, Umeed e Sahar, Sara Khalid, Dr. Sarah Maryam, Muhammad Yousaf Farooq

The University of Lahore, Pakistan

pdf download

Download Full-Text Pdf



Background: Nonionic, low osmolar agents are now used nearly universally for intravenous (IV) contrast administration in computed tomography. The osmolarity of a contrast agent is considered to be responsible for adverse effects in patients injected with contrast media. With the increase in its utilization, acute adverse reactions are suspected to rise substantially. Regardless of the usage of low osmolar non-ionic agents to reduce adverse effects, a large number of reactions are still experienced by patients. However, the frequency of immediate adverse contrast reactions to various low osmolar non‐ionic iodinated contrast media is not well studied. A basic understanding of the occurrence, risk factors and clinical features of these reactions is important as it can help in ensuring optimal patient care. Objective: To determine the frequency and severity of acute adverse reactions related to administration of low osmolar iodinated contrast media to patients during contrast-enhanced computed tomography scans. Methods: A cross-sectional study of intravascular doses of low osmolar non-ionic iodinated contrast media administered from October 2018 to February 2018 was conducted on patients undergoing CT examinations at Combined Military Hospital, Lahore. Acute adverse effects were characterized by using the data collected. These effects were investigated for determining the frequency and severity of reactions. Results: A total of 328 low osmolar iodinated contrast doses were administered to patients coming for CT examinations. 209 cases of acute adverse effects (63.72%) were identified. 90 out of 139 (64.75%) females, 117 out of 189 (61.90%) males were affected. Mild reactions were in the majority with the most common being nausea, sweating, and change in taste. Two cases of moderate reactions and no severe/fatal reactions were found over the study period. One case necessitated transfer to the emergency for urgent care. Female patients were affected more than males. Conclusion: Acute adverse reactions to the administration of low-osmolar non-ionic iodinated contrast agents are rare. The severity of these reactions is governed by multiple aspects of an examination, but the majority of them are mild. Moderate and severe reactions occur infrequently. Ideal patient care can be very helpful to combat these reactions.


1.   Kyung E, Ryu J, Kim E. Evaluation of adverse reactions to contrast media in the hospital. The British journal of radiology. 2013;86(1032):20130418.

2.   Pasternak JJ, Williamson EE, editors. Clinical pharmacology, uses, and adverse reactions of iodinated contrast agents: a primer for the non-radiologist. Mayo Clinic Proceedings; 2012: Elsevier.

3.   Bottinor W, Polkampally P, Jovin I. Adverse reactions to iodinated contrast media. The International journal of angiology: official publication of the International College of Angiology, Inc. 2013;22(3):149.

4.   Thompsen H, Jaw W. Contrast media. Safety issues and ESUR guidelines Heidelberg: Springer. 2013.

5.   Solomon R. Contrast media: are there differences in nephrotoxicity among contrast media? BioMed research international. 2014;2014.

6.   Siddiqi N. Medscape reference [Internet]. New York: WebMD; Jul 22, 2017.[cited 2018 Apr 8]. Contrast medium reactions. c1994.

7.   Morzycki A, Bhatia A, Murphy KJ. Adverse reactions to contrast material: a Canadian update. Canadian Association of Radiologists Journal. 2017;68(2):187-93.

8.   Giannini G, Cuppo F, Fontanive L, D’Amelio N, Cesàro A, Maiocchi A, et al. Interactions in iodinated contrast media solutions. Journal of thermal analysis and calorimetry. 2011;103(1):89-94.

9.   Iyer RS, Schopp JG, Swanson JO, Thapa MM, Phillips GS. Safety essentials: acute reactions to iodinated contrast media. Canadian Association of Radiologists Journal. 2013;64(3):193-9.

10.  Prakkamakul S, Lerdlum S. Incidence and severity of acute adverse reactions to intravenous iodinated contrast media: 8-year experience in King Chulalongkorn Memorial Hospital. Asian Biomedicine. 2013;7(2):203-9.

11.  Rossi C, Reginelli A, D'Amora M, Di GG, Mandato Y, D'Andrea A, et al. Safety profile and protocol prevention of adverse reactions to uroangiographic contrast media in diagnostic imaging. Journal of biological regulators and homeostatic agents. 2014;28(1):155-65.

12.  Gharekhanloo F, Torabian S. Comparison of allergic adverse effects and contrast enhancement between iodixanol and iopromide. Iranian Journal of Radiology. 2012;9(2):63.

13.  Motosugi U, Ichikawa T, Sano K, Onishi H. Acute Adverse Reactions to Nonionic Iodinated Contrast Media for CT: Prospective Randomized Evaluation of the Effects of Dehydration, Oral Rehydration, and Patient Risk Factors. American Journal of Roentgenology. 2016;207(5):931-8.

14.  Watson N. Chapman & Nakielny's Guide to Radiological Procedures. 6th ed: Saunders Ltd; 2013 21 November. 428 p.

15.  Kim S, Lee J, Park K, Park H, Park J. Varied incidence of immediate adverse reactions to low‐osmolar non‐ionic iodide radiocontrast media used in computed tomography. Clinical & Experimental Allergy. 2017;47(1):106-12.

16.  Zhang B, Dong Y, Liang L, Lian Z, Liu J, Luo X, et al. The incidence, classification, and management of acute adverse reactions to the low-osmolar iodinated contrast media Isovue and Ultravist in contrast-enhanced computed tomography scanning. Medicine. 2016;95(12).

17.  Li X, Chen J, Zhang L, Liu H, Wang S, Chen X, et al. Clinical observation of the adverse drug reactions caused by non-ionic iodinated contrast media: results from 109,255 cases who underwent enhanced CT examination in Chongqing, China. The British journal of radiology. 2015;88(1047):20140491.

18.  Callahan MJ, Poznauskis L, Zurakowski D, Taylor GA. Nonionic iodinated intravenous contrast material–related reactions: incidence in large urban children's hospital—retrospective analysis of data in 12 494 patients. Radiology. 2009;250(3):674-81.

19.  Wang CL, Cohan RH, Ellis JH, Caoili EM, Wang G, Francis IR. Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions. American Journal of Roentgenology. 2008;191(2):409-15.

20.  Dillman JR, Strouse PJ, Ellis JH, Cohan RH, Jan SC. Incidence and severity of acute allergic-like reactions to iv nonionic iodinated contrast material in children. American journal of roentgenology. 2007;188(6):1643-7.

21.  Mortelé KJ, Oliva M-R, Ondategui S, Ros PR, Silverman SG. Universal use of nonionic iodinated contrast medium for CT: evaluation of safety in a large urban teaching hospital. American Journal of Roentgenology. 2005;184(1):31-4.

22.  Thomsen HS, Dorph S. High-osmolar and low-osmolar contrast media: an update on frequency of adverse drug reactions. Acta Radiologica. 1993;34(3):205-9.

23.  Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology. 1990;175(3):621-8.

24.  McDonald JS, McDonald RJ, Carter RE, Katzberg RW, Kallmes DF, Williamson EE. Risk of intravenous contrast material–mediated acute kidney injury: a propensity score–matched study stratified by baseline-estimated glomerular filtration rate. Radiology. 2014;271(1):65-73.

About Us

The Asian Institute of Research is an online and open-access platform to publish recent research and articles of scholars worldwide. Founded in 2018 and based in Indonesia, the Institute serves as a platform for academics, educators, scholars, and students from Asia and around the world, to connect with one another. The Institute disseminates research that is proven or predicted to be of significant influence for the general public.

Stay Connected

  • Instagram - Black Circle
  • Facebook - Black Circle
  • LinkedIn - Black Circle

Contact Us

Please send all inquiries to the email:

Business Address:

5th Floor, Kavling 507, Fajar Graha Pena Tower, Jl. Urip Sumohardjo No.20, Makassar, Indonesia 90234

Copyright © 2018 The Asian Institute of Research. All rights reserved