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Alterations of acid–base balance, electrolyte concentrations, and osmolality caused by nonionic hyperosmolar contrast medium during pediatric cardiac catheterization
Author(s) -
Dennhardt Nils,
Schoof Stephan,
Osthaus Wilhelm A.,
Witt Lars,
Bertram Harald,
Sümpelmann Robert
Publication year - 2011
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2011.03706.x
Subject(s) - medicine , hematocrit , hyponatremia , anion gap , bicarbonate , base excess , contrast medium , acid–base homeostasis , sodium bicarbonate , anesthesia , metabolic acidosis , sodium , chemistry , organic chemistry , radiology
Summary 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 m m , osmolality 284 ± 5.7 vs 294 ± 7.6 mosmol·kg −1 , P < 0.01). Seventy‐eight percent of the children developed hyponatremia (sodium <135 m m ). 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.