Besides anaphylaxis what is a major risk with regard to contrast media

Renal failure is a well-documented, severe reaction long associated with soluble contrast media, particularly in patients with disorders predisposing them to renal failure such as renal disease, diabetes, jaundice, multiple myeloma, hypovolemia and diminished renal blood flow from severe cardiac or vascular disease. Adequate hydration is absolutely necessary to decrease the impact on the patient. Furthermore, the necessity of the contrast study should always be considered. Particular caution must be used in patients taking metformin since renal failure in these patients can lead to severe, life-threatening lactic acidosis. For this reason it is recommended that metformin be held for 48 hours before performing any radiologic study in which contrast media are to be used.

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