SevereGadolinium (GBCA)
GBCA severe reaction / anaphylaxis
Recognize
- Anaphylaxis after gadolinium injection
- Laryngeal edema with stridor and/or hypoxia
- Severe bronchospasm with significant hypoxia
- Hypotension + tachycardia (anaphylactic shock)
- Diffuse edema with dyspnea
Act — tap each step
Routine stepCritical stepCompleted
Medications
| Drug | Dose | Route |
|---|---|---|
| Epinephrine IM | 0.3 mg (0.3 mL of 1 mg/mL) | IM lateral thigh FIRST-LINE. Repeat q5–15 min |
| Epinephrine IV | 0.1 mg (1 mL of 0.1 mg/mL) | IV slow push 2–5 min Only if hypotensive with IV access |
| Normal Saline | 1 L wide open | IV |
| Diphenhydramine | 25–50 mg | IV |
Notes
- Treatment is identical to iodinated contrast anaphylaxis.
- Severe GBCA reactions are extremely rare but can be fatal.
- Premedication recommended for future GBCA studies; consider switching to a different gadolinium agent.