title: Ionic versus nonionic contrast media: a prospective study of the effect of rapid bolus injection on nausea and anaphylactoid reactions.
abstract: OBJECTIVE
  The purpose of our study was to evaluate the effect of bolus infusion of contrast medium (ionic versus nonionic) on the incidence of nausea and anaphylactoid reactions.
  
  
  METHODS
  We prospectively studied 1,827 patients who had bolus enhanced body CT scans and divided them into four groups: 725 patients received higher osmolality contrast medium (HOCM) at the slower bolus rate of 1-2.5 ml/s (SLOW-HOCM group); 650 patients were in the FAST-HOCM group and received the same ionic contrast medium at 4-5 ml/s; 250 patients received lower osmolality contrast medium (LOCM) at 1-2.5 ml/s, forming the SLOW-LOCM group; and 202 patients in the FAST-LOCM group got the same nonionic agent at 4-5 ml/s.
  
  
  RESULTS
  We found no significant difference in the rate of nausea among the first three groups: SLOW-HOCM (3.9%), FAST-HOCM (4.9%), and SLOW-LOCM (3.2%). A statistically significant lower incidence of nausea (0.5%) was found in the FAST-LOCM group. Anaphylactoid reactions were significantly more common in both groups who received HOCM (8.3 and 9.1%) compared with the groups who received LOCM (2.0 and 2.5%).
  
  
  CONCLUSIONS
  The bolus injection of warmed ionic contrast medium at a rate of 1-2.5 ml/s causes no significant increase in nausea compared with similar infusion rates of nonionic agents. For CT protocols that require infusion rates of 4-5 ml/s, the use of a nonionic agent is associated with a significantly reduced prevalence of nausea. The prevalence of anaphylactoid reactions is not affected by the rate of injection.
authors.affiliation: University of Pittsburgh Medical Center, PA 15213, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Federle
authors.forename: L L
authors.initials: LL
authors.lastname: Willis
authors.forename: D P
authors.initials: DP
authors.lastname: Swanson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000139:chemically induced*; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects / Q000737:chemistry; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007482:Iothalamate Meglumine / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced*; D009994:Osmolar Concentration; D015995:Prevalence; D011446:Prospective Studies; D013696:Temperature; D014057:Tomography, X-Ray Computed; D014283:Triiodobenzoic Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry; D014839:Vomiting / Q000139:chemically induced
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol; D007482:Iothalamate Meglumine