What causes nausea, vomiting, and diarrhea after administration of Intravenous (IV) contrast?

From the Guidelines

Nausea, vomiting, and diarrhea after IV contrast are common adverse reactions that typically resolve within 24-48 hours without specific treatment. For mild symptoms, supportive care is recommended, including clear fluids to prevent dehydration and rest. Although the provided study 1 focuses on the evaluation and management of emergency department patients with suspected appendicitis, it highlights the potential disadvantages of IV contrast, including serious allergic reactions and renal failure. However, it does not specifically address the management of nausea, vomiting, and diarrhea after IV contrast.

In clinical practice, for moderate to severe symptoms, ondansetron 4-8 mg orally every 8 hours as needed can effectively control nausea and vomiting, while loperamide 4 mg initially followed by 2 mg after each loose stool (maximum 16 mg daily) can manage diarrhea. If symptoms persist beyond 48 hours, are accompanied by fever, severe abdominal pain, or signs of dehydration (dizziness, decreased urination, extreme thirst), immediate medical attention is necessary as these could indicate a more serious reaction.

Key considerations for managing these symptoms include:

• Providing supportive care for mild symptoms
• Using ondansetron and loperamide for moderate to severe symptoms
• Monitoring for signs of dehydration and other complications
• Informing healthcare providers about previous contrast reactions to consider premedication for future imaging studies.

It is essential to prioritize the patient's morbidity, mortality, and quality of life when managing these adverse reactions, ensuring prompt intervention for severe or persistent symptoms.

From the Research

Nausea, Vomiting, and Diarrhea after IV Contrast

• The provided studies do not directly address nausea, vomiting, and diarrhea after IV contrast administration as a primary topic.
• However, some studies mention the adverse effects of medication or contrast media, which may be related to the symptoms in question:
  • 2 discusses the evaluation and treatment of nausea and vomiting in adults, including the potential causes and management options.
  • 3 provides a practical 5-step approach to nausea and vomiting, considering medication or toxin adverse effects as a potential underlying cause.
• Regarding contrast media, the studies focus on contrast-induced nephropathy (CIN) and its prevention:
  • 4, 5, and 6 discuss the pathophysiology, risk factors, and prevention strategies for CIN.
  • 4 and 6 mention the importance of hydration and careful selection of patients to prevent CIN.
• There is no direct evidence in the provided studies to support a specific cause or treatment for nausea, vomiting, and diarrhea after IV contrast administration.
• Further research or consultation of additional studies may be necessary to address this specific topic.