Reactions Associated with Intravenous Urography: Discussion of Mechanisms and Therapy

Abstract

In A Previous communication (21), historical evidence was presented demonstrating that the use of iodide compounds for intravenous urography is increasing rapidly. In 1956, approximately 1,368,000 intravenous urographic examinations were performed in the United States alone, which is a fivefold increase in fourteen years. Serious reactions, even though uncommon, have become generally recognized hazards in urography. If the incidence of fatal reactions associated with intravenous urography between 1942 and 1952 is compared with the period between 1952 and 1956, the difference is not statistically significant. It is noteworthy, however, that fatal reactions during the last three years show an upward trend which may be indicative of their increasing occurrence (21). In any event, there is no doubt that, coincident with the greater use of intravenous urography, more fatal as well as nonfatal reactions are being reported each year. The procedure of intravenous urography is a necessary adjunct to the practice of clinical medicine. Effort must be directed, therefore, toward understanding the mechanisms of these reactions and their prophylaxis and therapy. In the following communication, an attempt is made to present what we think is the best available information. In addition to what is known, much ignorance must also, of necessity, be laid bare. Clinical Picture The clinical picture of reactions associated with intravenous urography is varied. Some types of reaction predominate, however, and a grouping on a clinical basis has thus become possible. I. Such signs and symptoms as pain in the arm, phlebitis, nausea, flushing, giddiness, tingling, numbness, and cough seem to be related to mild toxicity or in some cases to apprehension. They will not be discussed further. II. Symptoms that are probably unrelated to toxicity or pharmacological action, and that may be allergic in nature, may be mild or severe: a. Mild: Immediate onset of urticaria or conjunctivitis, with or without rhinitis, developing within minutes of the injection. Delayed exanthematous or urticarial eruptions, usually appearing hours after the injection. b. Severe: In this category are the reactions that endanger life. The most severe reactions include several of the symptoms listed in Table I. Certainly the most common manifestations in a series of 102 immediate fatal reactions following urography (1930–56) recorded in previous communications (19–21) were dyspnea, shock, cyanosis, pulmonary edema, convulsions, asthma, and retching. The terminal event was most often described as respiratory arrest, cardiac arrest, or “collapse.” In all probability, the chief cause of convulsions was anoxia, since they occurred only in those patients who were dyspneic or cyanotic.