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Radiologisch praxisrelevante Prophylaxe und Therapie von Nebenwirkungen jodhaltiger Kontrastmittel

Prophylaxis and treatment of side effects due to iodinated contrast media relevant to radiological practice

  • Leitthema: Kontrastmittelsicherheit
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Zusammenfassung

Durch den zunehmenden Einsatz jodhaltiger Kontrastmittel in der Radiologie steigt auch die Rate der Nebenwirkungen; zu den wichtigsten gehören die kontrastmittelinduzierte Nephropathie, anaphylaktoide Reaktion, thyreotoxische Krise und Extravasation.

Bei Patienten mit mittelgradig eingeschränkter Nierenfunktion wird eine Prophylaxe durch Hydrierung und Reduktion der KM-Menge empfohlen. Bei hochgradig eingeschränkter Nierenfunktion sollte die Kontrastmittelgabe nur noch kontrolliert im interdisziplinären Konsens erfolgen. Eine nachgewiesen wirkungsvolle Prophylaxe anaphylaktoider Reaktionen ist bisher nicht bekannt. Bei Nachweis einer sublatenten Hyperthyreose ist die Gabe von Natriumperchlorat eine sinnvolle Gegenmaßnahme.

Eine kontrastmittelinduzierte Nephropathie ist meistens transient und sollte mehrfach im Verlauf kontrolliert werden. Leichte allgemeine anaphylaktoide Reaktionen können mit Antihistaminika und Kortikosteroiden behandelt werden.

Auch die Wahl des Röntgenkontrastmittels könnte Einfluss auf das Risiko von Nebenwirkungen haben.

Abstract

Increased utilization of iodinated contrast media may be associated with increased incidence of adverse events. The most important side effects include contrast-induced nephropathy, anaphylactoid reaction, thyrotoxicosis, and extravasation.

In patients with moderate renal dysfunction, saline hydration and reduction of contrast media volume are recommended. No regime to prevent anaphylactoid reactions has yet proven to be efficient. If subclinical hyperthyroidism has been determined, prophylaxis with sodium perchlorate is advised.

Contrast-induced nephropathy is commonly transient and needs to be followed over time. Mild general anaphylactoid reactions may be treated with antihistaminic drugs and corticosteroids.

Furthermore the choice of the X-ray contrast media might influence the risk of any adverse effects.

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  1. Institut für Klinische Radiologie, Klinikum Großhadern der Ludwig-Maximilians-Universität München , Marchioninistr. 15, 81377, München, Deutschland

    C. Becker

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Becker, C. Radiologisch praxisrelevante Prophylaxe und Therapie von Nebenwirkungen jodhaltiger Kontrastmittel. Radiologe 47, 768–773 (2007). https://doi.org/10.1007/s00117-007-1550-4

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  • DOI: https://doi.org/10.1007/s00117-007-1550-4

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