Life-threatening hypotensive reactions to contrast media administration: comparison of pharmacologic and fluid therapy.

Nine patients were studied retrospectively and 21 prospectively to ascertain the effectiveness and complications of three therapeutic regimens for life-threatening hypotensive reactions (systolic blood pressure 50 mm Hg or less) to intravenous (IV) contrast media. Initial treatment was pharmacologic in nine patients, with fluid in 14 and combined fluid-pharmacologic in seven. All nine patients treated initially with epinephrine required fluid volume administration to restore blood pressure. Thirteen of 14 patients initially treated with fluids (0.5-3 liters) required no other therapy. All patients treated with the combined regimen responded satisfactorily. Complications of drug therapy included six-beat ventricular tachycardia and ventricular bigeminy (epinephrine) and exacerbated hypotension (diphenhydramine hydrochloride). No pulmonary edema was encountered as a complication of fluid therapy. Fluid therapy, alone or with drugs, with electrocardiographic monitoring appears to be a safe and effective method of treating severe IV contrast agent-induced hypotension. Pharmacologic therapy alone in the doses the authors used is often ineffective and may cause major complications.