Contrast Media In Children

CONTRAST MEDIA IN CHILDREN
Principles regarding contrast media utilization and associated adverse events are generally similar between children and adults. This section will address specific areas in which pediatric use of contrast material differs from adult use and attempt to avoid repeating recommendations that are similar for both patient populations. contrast media. As viscosity increases, the pressure associated with IV contrast medium injection increases. This physical property is especially important for pediatric patients due to the use of small gauge angiocatheters in tiny blood vessels. Contrast medium viscosity and angiocatheter size are important factors in determining maximum injection rates. If a rapid injection rate is desired
A few key differences are discussed below. Measurement of Renal Function in Children Serum creatinine concentration reflects the balance between creatinine production and excretion. Creatinine is a break-down product of skeletal muscle, and its rate of production is proportional to muscle mass. Muscle mass depends on a variety of factors, including patient age, gender, and level of physical activity. Normal serum creatinine concentrations, thus, are quite variable in pediatric patients, even in the presence of preserved renal function. It is important to recognize that normal adult creatinine concentrations cannot be applied to the pediatric population. Normal pediatric serum creatinine concentrations increase with age, with the upper limits of normal always less than adult values (note: age-based normal serum creatinine concentrations also may vary slightly from laboratory to laboratory). There are problems with using serum creatinine concentration as the sole marker of renal function. First, a normal serum creatinine value does not mean that renal function is preserved. For example, an increase in creatinine from 0.4 mg/dl to 0.8 mg/ml in a 10-year old patient would be clinically significant and suggest some degree of renal impairment, even though both measurements may be within acceptable limits for patient age. Serum creatinine concentration may not become abnormal until glomerular filtration
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agents. Pediatr Nephrol 2008; 23:21212129. Gunn VL, Nechyba C, ed. The Harriet Lane handbook: a manual for pediatric house officers. 16th ed. Philadelphia, Pa: Mosby; 2002. Cohen MD. Choosing contrast media for the evaluation of the gastrointestinal tract of neonates and infants. Radiology 1987; 162:447-456. Friedman BI, Hartenberg MA, Mulroy JJ, Tong TK, Mickell JJ. Gastrografin aspiration in a 3 3/4-year-old girl. Pediatr Radiol 1986; 16:506-507. McAlister WH, Siegel MJ. Fatal aspirations in infancy during gastrointestinal series. Pediatr Radiol 1984; 14:81-83.

Table A Sample Pediatric Corticosteriod and Antihistamine Premedication Regimen Dosage Prednisone Diphenhydramine 0.5-0.7 mg/kg PO (up to 50 mg) 1.25 mg/kg PO (up to 50 mg) Timing 13, 7, and 1 hrs prior to contrast injection 1 hr prior to contrast injection

Note: Appropriate intravenous doses may be substituted for patients who cannot ingest PO medication.

Manual on Contrast Media – Version 7, 2010

Contrast Media in Children /