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Amidotrizoic Acid/Barium Sulfate 1477 Imbalance Should Be Corrected Before Contrast Media Are Given

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Amidotrizoic Acid/Barium Sulfate 1477 Imbalance Should Be Corrected Before Contrast Media Are Given Amidotrizoic Acid/Barium Sulfate 1477 imbalance should be corrected before contrast media are given. management of adhesive small bowel obstruction;2 they allow pyloric stenosis or lesions that may predispose to obstruction. Particular care is needed in patients with multiple myeloma since identification of patients who require surgery and, although they Adequate hydration should be ensured after the procedure to pre- dehydration resulting from use of contrast media may cause pre- have not been shown to relieve obstruction, they may reduce vent severe constipation. cipitation of protein in the renal tubules, leading to anuria and length of hospital stay in patients treated without surgery. It is contra-indicated in patients with gastrointestinal perforation, fatal renal failure. 1. Murshed R, et al. Meconium ileus: a ten-year review of thirty-six and should be avoided, particularly when given rectally, in those Caution is also necessary in patients with severe hypertension, patients. Eur J Pediatr Surg 1997; 7: 275–7. at risk of perforation, such as patients with acute ulcerative colitis advanced cardiac disease, phaeochromocytoma, sickle-cell dis- 2. Abbas S, et al. Oral water soluble contrast for the management or diverticulitis and after rectal or colonic biopsy, sigmoidosco- of adhesive small bowel obstruction. Available in The Cochrane ease, or hyperthyroidism or epilepsy, and in debilitated, severely Database of Systematic Reviews; Issue 3. Chichester: John Wi- py, or radiotherapy. ill, very old, or very young patients. ley; 2007 (accessed 14/07/08). Uses and Administration Amidotrizoates and other hypertonic contrast media are neuro- Preparations Barium sulfate is used as a radiographic contrast medium toxic and should not be given intrathecally; patients with sub- (p.1474) for X-ray examination of the gastrointestinal tract in- arachnoid haemorrhage may be at risk with any intravascular BP 2008: Meglumine Amidotrizoate Injection; Sodium Amidotrizoate In- jection; volving single- or double-contrast techniques or computed tom- use. Intravascular contrast media should also be used with cau- USP 31: Diatrizoate Meglumine and Diatrizoate Sodium Injection; Diatri- ography. tion in any patient with occlusive vascular disease. Iodinated zoate Meglumine and Diatrizoate Sodium Solution; Diatrizoate Meglumine contrast media should not be used for hysterosalpingography in Injection; Diatrizoate Sodium Injection; Diatrizoate Sodium Solution. The dose of barium sulfate is dependent upon the type of exam- the presence of infection or inflammation of the pelvic cavity, nor ination and technique used. In the UK typical doses and concen- Proprietary Preparations (details are given in Part 3) trations used for examination are: during menstruation or in pregnancy (although any abdominal Arg.: Angiografina; Densopax; Hypaque 60%†; Hypaque 76%†; MD-76; radiography should be avoided during pregnancy because of the MD-Gastroview; Plenigraf; Temistac; Tomoray; Triyosom; Urografina; Urovi- • oesophagus: up to 150 mL of a 50 to 200% w/v suspension risks of radiation to the fetus). sona; Austral.: Angiografin†; Gastrografin; MD-60†; MD-76; MD-Gastro- given orally view; Urografin; Austria: Gastrografin; Urografin†; Belg.: Gastrografin; Iodine-containing contrast media may interfere with thyroid Urografine†; Braz.: Hypaque; Hypaque-M; Urografina; Canad.: Hypaque- • stomach and duodenum: up to 300 mL of a 30 to 200% w/v function tests. There may also be interference with blood coagu- M†; Hypaque†; MD-76; Chile: Angiovist; Hypaque 60%†; Hypaque 76%†; suspension given orally lation tests and certain urine tests. Pielograf†; Reliev; Reliev 76%; Cz.: Urografin†; Denm.: Urografin; Urografin Meglumin; Fin.: Gastrografin; Fr.: Gastrografine; Radioselectan; Ger.: Ethi- • small intestine: 100 to 300 mL of a 30 to 150% w/v suspen- Breast feeding. No adverse effects have been seen in breast- bloc; Gastrografin; Gastrolux; Peritrast; Peritrast comp; Peritrast-Infusio sion given orally 160/32%†; Peritrast-Infusio 180/31%; Peritrast-Oral CT; Peritrast-Oral-GI; feeding infants whose mothers were receiving amidotrizoates • colon: 200 mL to 2 litres of a 20 to 130% w/v suspension giv- 1 Peritrast-RE; Urolux; Urolux Retro; Urovison†; Gr.: Gastrografin; Hung.: and the American Academy of Pediatrics considers that they are Gastrografin; Peritrast; India: Urografin; Israel: Urografin†; Ital.: Gastro- en as an enema. therefore usually compatible with breast feeding. grafin; Neth.: Angiografin†; Gastrografin; Urografin; Urovison†; Norw.: Gastrografin; NZ: Gastrografin; Urografin; Port.: Gastrografina; Urografina; A suspension containing 1.6 to 2.2% may be used in gastrointes- 1. American Academy of Pediatrics. The transfer of drugs and oth- Rus.: Hypaque (Гипак)†; Trazograph (Тразограф); Urographin tinal computed tomography. er chemicals into human milk. Pediatrics 2001; 108: 776–89. (Урографин); S.Afr.: Angiografin†; Gastrografin; Urografin; Spain: Gastro- Correction. ibid.; 1029. Also available at: grafin; Pielograf; Plenigraf; Radialar 280; Trazograf; Uro Angiografin; Uro- In the USA, suspensions containing up to 230% w/v barium sul- http://aappolicy.aappublications.org/cgi/content/full/ grafin; Swed.: Gastrografin; Urografin; Switz.: Gastrografin; Urografin†; fate may be used; lower concentrations are available for use in pediatrics%3b108/3/776 (accessed 27/03/06) UK: Gastrografin; Hypaque; Urografin 150 and 370; USA: Cystografin; Gas- computed tomography and usually contain about 1 to 2% w/v. trografin; Hypaque; Hypaque-M, Hypaque-76; MD-76; MD-Gastroview; Neonates. Although amidotrizoates may be used in the man- Reno-M; Renografin; Venez.: Hypaque-M†. For double-contrast examination, gas can be introduced into the agement of some forms of intestinal obstruction (see below), gastrointestinal tract by using suspensions of barium sulfate con- meglumine amidotrizoate was considered1 a possible contributo- Multi-ingredient: USA: Sinografin. taining carbon dioxide; separate gas-producing preparations ry factor in the deaths of 2 infants who developed bowel necrosis, based on sodium bicarbonate are also available. Air given via a perforation, and peritonitis after its use for meconium ileus. tube may be used as an alternative to carbon dioxide. 1. Leonidas JC, et al. Possible adverse effects of methylglucamine Barium Sulfate ◊ Reviews. diatrizoate compounds on the bowel of newborn infants with meconium ileus. Radiology 1976; 121: 693–6. Barii sulfas; Barii Sulphas; Bario sulfatas; Barium Sulfuricum; Bari- 1. Nolan DJ, Traill ZC. The current role of the barium examination um Sulphate; Bariumsulfaatti; Bariumsulfat; Bárium-szulfát; Baru of the small intestine. Clin Radiol 1997; 52: 809–20. Pharmacokinetics siarczan; Baryum (Sulfate de); Baryum, sulfate de; Síran barnatý; 2. Mendelson RM. The role of the barium enema in the diagnosis Amidotrizoates are very poorly absorbed from the gastrointesti- Sulfato de bario. of colorectal neoplasia. Australas Radiol 1998; 42: 191–6. nal tract. Amidotrizoates in the circulation are not significantly 3. de Zwart IM, et al. Barium enema and endoscopy for the detec- bound to plasma proteins. If renal function is not impaired, BaSO4 = 233.4. tion of colorectal neoplasia: sensitivity, specificity, complica- unchanged amidotrizoate is rapidly excreted by glomerular CAS — 7727-43-7. tions and its determinants. Clin Radiol 2001; 56: 401–9. filtration; over 95% of an intravascular dose is reported to be ex- ATC Vet — QV08BA02. 4. Rubesin SE, Maglinte DD. Double-contrast barium enema tech- creted in urine within 24 hours, and about 1 to 2% of a dose may Pharmacopoeias. In Chin., Eur. (see p.vii), Int., Jpn, US, and nique. Radiol Clin North Am 2003; 41: 365–76. be excreted in faeces. Trace amounts may be detected in other Viet. 5. O’Connor SD, Summers RM. Revisiting oral barium sulfate con- trast agents. Acad Radiol 2007; 14: 72–80. body fluids including tears and saliva. Faecal excretion may in- Ph. Eur. 6.2 (Barium Sulphate). A fine, white powder, free from crease to 10 to 50% in severe renal impairment. The half-life of gritty particles. Practically insoluble in water and in organic sol- Intussusception. Contrast media enemas and ultrasound are amidotrizoates has been reported to be 30 to 60 minutes, which vents; very slightly soluble in acids and in solutions of alkali hy- both used in the diagnosis of intussusception, a condition in in- can increase to 20 to 140 hours in severe renal impairment. They droxides. fants where part of the intestine prolapses into the lumen of an are removed by haemodialysis and peritoneal dialysis. USP 31 (Barium Sulfate). A fine, white, odourless, bulky pow- adjacent part causing an obstruction.1,2 However, some consider The amidotrizoates cross the placenta and are distributed into der, free from grittiness. Practically insoluble in water, in organic ultrasound to be superior for diagnosis and reserve enemas for breast milk. solvents, and in solutions of acids and of alkalis. pH of a the therapeutic reduction of intussusception. Reduction is 10% w/w aqueous suspension is between 3.5 and 10.0. achieved as a result of the hydrostatic pressure of the enema Uses and Administration pushing the intestine back into its natural position. Although The amidotrizoates are ionic monomeric iodinated radiographic Adverse Effects there is extensive experience using barium enemas for reduction contrast media (p.1474). Both the sodium and the meglumine Because barium sulfate is almost insoluble it lacks the severe some
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