title: Alterations of acid-base balance, electrolyte concentrations, and osmolality caused by nonionic hyperosmolar contrast medium during pediatric cardiac catheterization.
abstract: OBJECTIVE
  This prospective clinical observational study was conducted to investigate the effects of contrast medium on acid-base balance, electrolyte concentrations, and osmolality in children.
  
  
  BACKGROUND
  For pediatric cardiac catheterization, high doses of nonionic hyperosmolar contrast medium are widely used.
  
  
  METHODS
  Forty pediatric patients (age 0-16 years) undergoing cardiac angiography with more than 3 ml·kg(-1) of nonionic hyperosmolar contrast medium (Iomeprol) were enrolled, and the total amount of the contrast agent given was documented. Before and after contrast medium administration, a blood sample was collected to analyze electrolytes, acid-base parameters, osmolality, hemoglobin, and hematocrit.
  
  
  RESULTS
  After cardiac catheterization, pH, hemoglobin, hematocrit, bicarbonate, base excess, sodium, chloride, calcium, anion gap and strong ion difference decreased, whereas osmolality increased significantly (base excess -1.8 ± 1.8 vs -3.4 ± 2.3, sodium 138 ± 2.9 vs 132 ± 4.1 mm, osmolality 284 ± 5.7 vs 294 ± 7.6 mosmol·kg(-1), P < 0.01). Seventy-eight percent of the children developed hyponatremia (sodium <135 mm). No changes were seen in pCO(2) , lactate, and potassium levels.
  
  
  CONCLUSIONS
  Regarding the differential diagnosis of metabolic disturbances after pediatric cardiac catheterization, low-anion gap metabolic acidosis and hyponatremia should be considered as a possible side effect of the administered contrast medium.
authors.affiliation: Department of Anesthesiology, Hannover Medical School, Hannover, Germany. dennhardt.nils@mh-hannover.de
authors.forename: Nils
authors.initials: N
authors.lastname: Dennhardt
authors.forename: Stephan
authors.initials: S
authors.lastname: Schoof
authors.forename: Wilhelm A
authors.initials: WA
authors.lastname: Osthaus
authors.forename: Lars
authors.initials: L
authors.lastname: Witt
authors.forename: Harald
authors.initials: H
authors.lastname: Bertram
authors.forename: Robert
authors.initials: R
authors.lastname: Sümpelmann
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000138:Acidosis / Q000139:chemically induced; D000293:Adolescent; D001794:Blood Pressure / Q000187:drug effects; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000009:adverse effects* / Q000737:chemistry; D004573:Electrolytes / Q000097:blood*; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016343:Monitoring, Intraoperative; D009994:Osmolar Concentration; D011446:Prospective Studies; D012964:Sodium / Q000097:blood
chemical_list: D003287:Contrast Media; D004573:Electrolytes; D006454:Hemoglobins; D012964:Sodium