Iohexol

Abstract

Contrast media extravasation followed by off-label use: case report A 47-year-old woman developed contrast media extravasation during off-label treatment with iohexol contrast. The woman, 94kg and 165cm, suffered a second and third-degree burns of 55% of the body surface as well as inhalation trauma in a car fire. The burns occurred on the face, trunk, forearms, and thighs. Since the installation of intravenous accesses was frustrating, the rescue service provided a proximal pretibial intraosseous access to both lower legs. She was intubated at the scene of the accident, mechanically ventilated and taken by rescue helicopter to the emergency room. Complications or abnormalities in the installation of the entrances on the part of the rescue service personnel were not reported. The system was carried out for anesthesia initiation and volume therapy. As part of the primary care, a whole-body CT scan was carried out. There was no evidence of a misalignment, and iohexol [Accupaque 350; GE Healthcare] 80ml was administered via the off-label left intraosseous access. A CT scan showed perforation of the dorsal cortex of the left tibia through the cannula and an extensive extravasation of contrast in the soft tissue of the left lower leg was observed, which was attributed to iohexol [duration of treatment to reaction onset not stated]. The infusion was immediately stopped and the access was removed. During the subsequent wound debridement, a split of the muscle fascia of the left lower leg was carried out for the prevention of compartment syndrome. As a result, there was no critical minor perfusion of the affected limb was observed. In the course of intensive care therapy at the ICU, she developed a wound infection of the burned skin areas caused by Pseudomonas aeruginosa. That was not controlled by surgical rehabilitation and antiinfective therapy. Subsequently, she developed a septic multi-organ failure after several weeks and died.