[Respiratory distress in adults and disseminated intravascular coagulation after administration of iodinated contrast].
We report a patient with urinary sepsis who, during intravenous urography with iodinated contrast (70 mg Na, Ca diatrizoate and meglumine) developed dyspnea, tachypnea, sinus tachycardia and moderate hypoxemia (pO2: 72 with FiO2 of 0.21). She subsequently developed adult respiratory distress syndrome (ARDS) with refractory hypoxemia (pO2: 40 mmHg with FiO2 of 0.5) and disseminated intravascular coagulation (DIC) (prothrombin index: 5%, platelets: 20,000/mm3, APTT: 102/37 min, FDP: 80 ng/ml, and fibrinogen: 120 mg %). The patient required mechanical ventilation and treatment with inotropic drugs, antibiotics, corticosteroids, plasma, platelets and erythrocytes. The outcome was favorable, and she could be discharged from the Reanimation Service 7 days after admission. In severe systemic reactions to iodinated contrasts (SRIC), ARDS and DIC are common. In our patient, the close temporal association between the administration of iodinated contrast and the development of the clinical picture made us suspect their possible causal relation. A higher predisposition to SRIC in patients with sepsis has been reported. We review the SRIC in which the anesthesiologist may play a role for reanimation.
Bisbe
E
E
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital de l'Esperança, Barcelona.
Escolano
F
F
Díez
A
A
Castaño
J
J
D003287:Contrast Media / Q000009:adverse effects*; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced*; D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D006801:Humans; D007455:Iodine / Q000009:adverse effects*; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000139:chemically induced*
D003287:Contrast Media; D007455:Iodine
Distrés respiratorio del adulto y coagulación intravascular diseminada tras la administración de contraste yodado.