Dexamethasone/epinephrine/gadoxetate disodium
- PDF / 152,412 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 27 Downloads / 135 Views
1 S
Various toxicities following off-label dose and lack of efficacy: case report A 56-year-old woman developed allergic-like reaction with facial oedema, dyspnoea, laryngeal oedema, stridor, hypoxia, hypotensive shock, loss of consciousness and urinary incontinence while receiving gadoxetate disodium at an off-label dose as a contrast media. Additionally, she exhibited lack of efficacy with dexamethasone and epinephrine for allergic-like reaction and hypotensive shock. The woman, who had breast cancer, was referred for liver MRI for ruling out metastasis. She was injected with contrast media IV gadoxetate disodium at a dose of 10mL (~1.5 times the recommended dose) from a catheter placed in her hand vein at a rate of 1.5 mL/s followed by a 0.9% sodium chloride [saline] 20mL flush with a high-pressure injector at the same rate. The gadoxetate disodium dosing was off-label (recommended dose: 0.025 mmol/kg body weight, equal to 0.1 mL/kg). Around 1 min following gadoxetate disodium injection, a deterioration of the quality of hepatic arterial phase images was observed. She stated that she could not hold her breath. Following verbal reassurance, hepatic venous phase sequence was repeated. However, the image quality remained poor. She reported swelling of her throat and head, and she requested discontinuation of the examination. The woman’s examination was discontinued. The radiographer entered the scanning room and observed bilateral blepharoedema as well as sweat on her face. She was found to have developed facial oedema, dyspnoea, laryngeal oedema, stridor and hypoxia. She was immediately removed from the magnet, and she received IV dexamethasone 10mL timely; however, her condition deteriorated progressively with loss of consciousness, urinary incontinence and wheezing over the following 5 min. She was moved to an emergency department. Oropharyngeal airway and sputum aspiration was established following which she gradually regained consciousness, with a BP of 50/30mm Hg. She exhibited hypotensive shock. Therefore, she was administered IV epinephrine 0.2mg. At around 1 hour following gadoxetate disodium injection, she was moved to the respiratory ICU for further treatment. Cold extremities and skin flushing were observed. Her BP was 50/30mm Hg. Allergy-like reaction with gadoxetate disodium and lack of efficacy to dexamethasone and epinephrine treatment was considered. She received oxygen inhalation via a nasal tube. She underwent placement of peripherally inserted central venous catheters for unspecified drug therapy and fluid supplementation. Her electrolyte balance and other supportive therapy were maintained. Subsequently, her facial oedema improved. Her BP returned to normal 4.5 hours following gadoxetate disodium injection and remained stable over the following 2 days. On the noon of day 3, she was discharged in a good condition. Yao F-F, et al. Life-Threatening Allergic-Like Reaction After Intravenous MRI Liver-Specific Contrast Media Gadoxetate Disodium: A Case Report. Journal of Magnetic 803500625 Resonance
Data Loading...
