Generic name: diatrizoate meglumine
Dosage form: Injection
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Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
Reno-DIP (Diatrizoate Meglumine Injection USP 30%) should be at body temperature when administered and may need to be warmed before use.
Drip Infusion Pyelography
While preparation of the patient is not essential for drip infusion pyelography, it is advocated by some investigators. If desired, adults and older children may be given a laxative the night before the examination and a low residue diet the day before, to clear the gastrointestinal tract. Clinicians who feel that partial dehydration enhances radiographic contrast recommend a low liquid intake for 12 hours prior to the procedure; however, adequate hydration has improved the quality of films for other investigators. Preparatory partial dehydration is not recommended in infants, young children, the elderly, or azotemic patients (especially those with polyuria, oliguria, diabetes, advanced vascular disease, or preexisting dehydration). The undesirable dehydration in these patients may be accentuated by the osmotic diuretic action of the medium.
In uremic patients partial dehydration is not necessary and maintenance of adequate fluid intake is particularly desirable.
Cleansing enemas are not recommended, since they may increase residual gas in the bowel.
The recommended dose is 2 mL per pound of body weight. The preparation is given by continuous intravenous infusion, over a period of 8 minutes or longer (see PRECAUTIONS), through a needle with a large bore, usually a 17- or 18-gauge needle. In older patients and in patients with known or suspected cardiac decompensation, a slower rate of infusion is probably wise.
If nausea or flushing occurs during administration, the infusion should be slowed or briefly interrupted.
Films are taken before the onset of the infusion and at the desired intervals following its completion. When renal function is normal, a nephrogram may be taken as soon as the infusion is completed, and films of the collecting system at 10 and 20 minutes thereafter. Voiding cystourethrograms are usually optimal at 20 minutes after the infusion is completed. In hypertensive patients, early minute sequence films may be taken during the course of infusion, in addition to subsequent pyelograms. In patients with renal dysfunction, optimal visualization is usually delayed, and the late films are taken as indicated.
The nephrogram obtained by the drip infusion procedure may be dense enough to obscure the pelvocalyceal system in some cases. The presence of gas in the bowel may hamper early visualization of the renal collecting system. Tomographic “cuts” may help to overcome such difficulties.
Nephrotomography may begin when the infusion is completed. The sustained contrast achieved by the drip infusion technique eliminates the need for precise timing and teamwork that is necessary with ordinary nephrotomography. Thus, if nephrograms taken after infusion of the medium suggest the need for sectional films, or if preselected tomographic“cuts” are not sufficient, additional tomograms may be obtained at once, and without repetition of dosage.
The suggested dose is 2 mL per pound of body weight by intravenous drip over a period of eight minutes or longer; scanning may be performed during administration and/or immediately afterwards.
The usual adult dose is 300 mL administered by intravenous infusion over a period of approximately 20 minutes; 150 mL may be infused immediately prior to scanning, and the balance during scanning. Scanning may also be performed immediately following completion of infusion of the entire dose.
Gastrografin® (Diatrizoate Meglumine and Diatrizoate Sodium Solution USP), an oral radiopaque contrast agent, may be useful as an adjunct to the procedure.
Lower Extremity Venography
Appropriate premedication, which may include an analgesic, a barbiturate, or a tranquilizer may be administered prior to the examination.
Prior to the administration of the contrast agent, patients should be well hydrated and a preliminary radiograph taken. The patient should be placed on a tilt table, semi-erect (30° to 60°).
The usual dose per intravenous injection may range from 50 to 100 mL; the usual total dose per extremity ranges from 100 to 300 mL. The dose for children should be reduced in proportion to body weight. The dose may be given as a bolus injection or by steady drip infusion. Radiographs are taken at the start of injection/infusion and periodically thereafter at the discretion of the radiologist.
Following the procedure, the contrast agent may be removed from the venous system by flushing with either Dextrose Injection USP 5% or Sodium Chloride Injection USP 0.9%, or by leg massage and/or leg elevation.