Adverse reactions to iodinated contrast media

Adverse reactions to iodinated contrast media (ICM) are more likely to deve lop in patients with asthma, a history of allergy or contrast reaction and in those who are debilitated or medically unstable. These reactions can be divided into renal and general, and the latter are subdivided into acute an d delayed. Acute general reactions can be minor, intermediate or severe. Fa tal reactions are rare. The introduction of low-osmolality agents has cause d an overall reduction in the number of non-fatal contrast reactions. Promp t recognition and treatment of acute adverse side effects to ICM is invalua ble and may prevent a reaction from becoming severe. Familiarity with cardi opulmonary resuscitation is essential for successful management of life-thr eatening reactions. Contrast-media-induced renal impairment can be reduced with the use of low-osmolality contrast media and extracellular volume expa nsion. The use of ICM in diabetic patients receiving metformin should be ca rried out with care to avoid metformin-induced lactic acidosis. However, th is problem is mainly observed in patients with diabetic nephropathy.