High performance liquid chromatography with multiwavelength detection: a technique for identification of iodinated x-ray contrast agents in human body fluids and brain tissue.
OBJECTIVE
Several cases of a severe adverse reaction, referred to as "ascending tonic-clonic seizure syndrome," have been reported after administration of water-soluble iodinated x-ray contrast agents for myelographic examinations. Because of the bizarre reactions, the identities of the causative contrast media were questioned.


METHODS
Analyses of biologic materials from four of these patients were performed by using reverse-phase high-performance liquid chromatography. The chromatographic system was equipped with a fast-scanning UV-visible detector for the analysis of the UV-spectra of the chromatographic peaks.


RESULTS
The analyses revealed that the nonionic contrast agents iohexol or ioversol were not present in detectable amounts in any of the samples. On the other hand, the chromatographic analyses revealed peaks that cochromatographed with and showed the same UV-spectra as the ionic agents diatrizoate, metrizoate, and ioxitalamate.


CONCLUSIONS
The results indicate inadvertent injection of ionic contrast medium in all four cases.
Jacobsen
P B
PB
Department of Bioanalysis and Biochemistry, Nycomed Imaging AS, Torshov, Oslo, Norway.
D001826:Body Fluids / Q000737:chemistry*; D001923:Brain Chemistry; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects* / Q000032:analysis; D003974:Diatrizoate Meglumine / Q000032:analysis; D006801:Humans; D007278:Injections, Spinal; D007472:Iohexol / Q000032:analysis; D008794:Metrizoic Acid / Q000031:analogs & derivatives / Q000032:analysis; D009192:Myelography; D009994:Osmolar Concentration
D003287:Contrast Media; D003974:Diatrizoate Meglumine; D007472:Iohexol; D008794:Metrizoic Acid; C021342:methylglucamine metrizoate