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Disseminated Intravascular Coagulation and Hypotension After Intravasation of Barium

Disseminated Intravascular Coagulation and Hypotension After Intravasation of Barium Abstract • Prolonged hypotension and disseminated intravascular coagulation were seen in a patient after intravasation of barium sulfate contrast medium during a barium enema examination. High endotoxin levels were measured in the contrast material. In vitro, this material induced generation of bradykinin. The clinical features observed may be explained by contact activation of the Hageman factor—dependent pathways caused by the contrast material and/or by circulating endotoxins. Treatment of this rare but severe complication occurring during a barium enema procedure should be directed against the endotoxic shock. (Arch Intern Med 1983;143:1253-1255) References 1. Ansell G: Complications in Diagnostic Radiology . Oxford, England, Blackwell Scientific Publications, 1976, pp 339-360. 2. Seaman WB, Wells J: Complications of the barium enema. Gastroenterology 1965;48:728-737. 3. Juler GL, Dietrich RW, Eisenman MD: Intramesenteric perforation of sigmoid diverticulitis with nonfatal venous intravasation. Am J Surg 1975;56:553-656. 4. Burt C: Pneumatic rupture of the intestinal canal. Arch Surg 1931;22: 875-882.Crossref 5. Colman RW: Formation of human plasma kinin. N Engl J Med 1974;291:509-515.Crossref 6. Mason JW, Kleeberg U, Dolan P, et al: Plasma kallikrein and Hageman factor in gram-negative bacteremia. Ann Intern Med 1970;73:545-551.Crossref 7. Ogston D, Bennett B: Surface mediated reactions in the formation of thrombin, plasmin and kallikrein. Br Med Bull 1978;34:107-112. 8. Thomson J: Heriditary coagulation disorders, laboratory techniques , in Thomson J (ed): Blood Coagulation and Hemostasis , ed 2. New York, Churchill Livingstone, 1980, pp 117-157. 9. Kahlé LH, Schipper HG, Jenkins GSP, et al: Evaluation of an automated antithrombin III method. Thromb Res 1978;12:1003-1014.Crossref 10. Van Rosevelt R, Mulder A, Philipse-Hoornweg EM, et al: A simple and rapid RIA for plasma bradykinin. Clin Chem Acta 1982;126:81-89.Crossref 11. Thomas LLM, Sturk A, Schaap MC, et al: Quantitative endotoxin determination in blood with a chromogenic substrate. Clin Chem Acta 1981;116:63-68.Crossref 12. O'Donnell TF, Clowes GHA, Talamo RC, et al: Kinin activation in the blood of patients with sepsis. Surg Gynecol Obstet 1976;143:539-545. 13. Nelsestuen GL, Zytkovics TH, Howard JB: Gamma-carboxy-glutamic acid: Identification and distribution in vitamin K-dependent proteins. Mayo Clin Proc 1974;49:941-966. 14. Morrison DC, Cochrane CG: Direct evidence for Hageman factor (F XII) activation by bacterial lipopolysaccharides (endotoxins). J Exp Med 1974;140:797-811.Crossref 15. Kimball MR, Melmon KL, Wolff S: Endotoxin induced kinin production in man. Proc Soc Exp Biol Med 1972;139:1078-1082.Crossref 16. Wolff S: Biological effects of bacterial endotoxins in man. J Infect Dis 1973;128( (suppl) ):259-264.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Disseminated Intravascular Coagulation and Hypotension After Intravasation of Barium

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350060185032
Publisher site
See Article on Publisher Site

Abstract

Abstract • Prolonged hypotension and disseminated intravascular coagulation were seen in a patient after intravasation of barium sulfate contrast medium during a barium enema examination. High endotoxin levels were measured in the contrast material. In vitro, this material induced generation of bradykinin. The clinical features observed may be explained by contact activation of the Hageman factor—dependent pathways caused by the contrast material and/or by circulating endotoxins. Treatment of this rare but severe complication occurring during a barium enema procedure should be directed against the endotoxic shock. (Arch Intern Med 1983;143:1253-1255) References 1. Ansell G: Complications in Diagnostic Radiology . Oxford, England, Blackwell Scientific Publications, 1976, pp 339-360. 2. Seaman WB, Wells J: Complications of the barium enema. Gastroenterology 1965;48:728-737. 3. Juler GL, Dietrich RW, Eisenman MD: Intramesenteric perforation of sigmoid diverticulitis with nonfatal venous intravasation. Am J Surg 1975;56:553-656. 4. Burt C: Pneumatic rupture of the intestinal canal. Arch Surg 1931;22: 875-882.Crossref 5. Colman RW: Formation of human plasma kinin. N Engl J Med 1974;291:509-515.Crossref 6. Mason JW, Kleeberg U, Dolan P, et al: Plasma kallikrein and Hageman factor in gram-negative bacteremia. Ann Intern Med 1970;73:545-551.Crossref 7. Ogston D, Bennett B: Surface mediated reactions in the formation of thrombin, plasmin and kallikrein. Br Med Bull 1978;34:107-112. 8. Thomson J: Heriditary coagulation disorders, laboratory techniques , in Thomson J (ed): Blood Coagulation and Hemostasis , ed 2. New York, Churchill Livingstone, 1980, pp 117-157. 9. Kahlé LH, Schipper HG, Jenkins GSP, et al: Evaluation of an automated antithrombin III method. Thromb Res 1978;12:1003-1014.Crossref 10. Van Rosevelt R, Mulder A, Philipse-Hoornweg EM, et al: A simple and rapid RIA for plasma bradykinin. Clin Chem Acta 1982;126:81-89.Crossref 11. Thomas LLM, Sturk A, Schaap MC, et al: Quantitative endotoxin determination in blood with a chromogenic substrate. Clin Chem Acta 1981;116:63-68.Crossref 12. O'Donnell TF, Clowes GHA, Talamo RC, et al: Kinin activation in the blood of patients with sepsis. Surg Gynecol Obstet 1976;143:539-545. 13. Nelsestuen GL, Zytkovics TH, Howard JB: Gamma-carboxy-glutamic acid: Identification and distribution in vitamin K-dependent proteins. Mayo Clin Proc 1974;49:941-966. 14. Morrison DC, Cochrane CG: Direct evidence for Hageman factor (F XII) activation by bacterial lipopolysaccharides (endotoxins). J Exp Med 1974;140:797-811.Crossref 15. Kimball MR, Melmon KL, Wolff S: Endotoxin induced kinin production in man. Proc Soc Exp Biol Med 1972;139:1078-1082.Crossref 16. Wolff S: Biological effects of bacterial endotoxins in man. J Infect Dis 1973;128( (suppl) ):259-264.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 1, 1983

References