Patients with sickle cell disease, homocystinuria, or active gout may receive intravenous contrast but should be well hydrated. Multiple myeloma has been considered a risk factor for contrast associated AKI in the past but this is not supported by recent literature.
Patients who report an allergy-like reaction to contrast may be premedicated according to protocol at the discretion of the radiologist. Resuscitation equipment and drugs should be readily available.
Patients who report “passing out” or who needed resuscitation after past contrast injections, should have iodinated contrast only if alternative testing will not provide a satisfactory result. Same should apply to patients with allergic asthma or multiple severe allergies.
Contrast reactions could be potentiated by anxiety. Therefore, if a patient is exceedingly anxious prior to contrast injection, they may be premedicated with: Midazolam, 2 mg IV titrated up to a maximum of 5 mg (contraindication = glaucoma)
Jessica Robbins, June 2015