Question of the Week

For December 7, 2021

A 70-year-old man who is currently hospitalized for treatment of acute pancreatitis reports increasing abdominal pain. His gastroenterologist recommends a contrast-enhanced CT scan of the abdomen and pelvis to evaluate for pancreatic necrosis. While you are counseling the patient about the risks and benefits of this study, he mentions that many years ago he had an allergic reaction, including flushing, pruritus, and wheezing, about one hour after receiving intravenous contrast. He has not received intravenous contrast since then.

Which one of the following next steps is most appropriate for this patient?

Administer prednisone and diphenhydramine before the CT scan, and use nonionic low-osmolality contrast media
Administer an intravenous test dose of contrast, and monitor for any reaction
Administer one liter of sodium bicarbonate solution immediately before the CT scan
Start 0.9% normal saline 2 hours before the CT scan, and continue for 6 hours afterward
Prescribe oral N-acetylcysteine 1200 mg before the CT scan, and repeat administration every 12 hours for 2 days