Hypernickelemia following coronary arteriography, caused by nickel in the radiographic contrast medium.

Meglumine diatrizoate ("Renografin-76", a radiographic contrast medium) contains sufficient nickel to cause hypernickelemia in patients after coronary arteriography. Nickel analyses by electrothermal atomic absorption spectrophotometry showed that nine lots of "Renografin-76" (760 g of meglumine diatrizoate per L) contained 144 +/- 44 micrograms Ni per L. Serum Ni concentrations became elevated in 11 patients after coronary arteriography (Ni dose = 19 +/- 4 micrograms per patient); peak Ni concentrations (increment = 1.8 +/- 0.4 micrograms Ni per L) occurred 0.25 or 0.5 h post-injection. Serum Ni concentrations diminished at 2 and 4 h post-injection and returned to base-line values at 24 h. The half-time (T1/2) for reduction of serum Ni concentrations averaged 1.5 h. Analysis of urine specimens from two patients showed that most of the Ni dose was excreted in urine within 24 hours. After iv administration of meglumine diatrizoate to rabbits (0.5 or 1.0 micrograms Ni per kg body wt), T1/2 values for elimination of Ni from the serum volume averaged 1.2 h, compared to T1/2 values of 5.7 and 7.4 h, respectively, when Ni was administered iv in NiCl2 or albumin solutions. Since "Renografin-76" contains edetate disodium (0.4 g per L), Ni is probably present as a Ni-EDTA complex, accounting for the rapid elimination of Ni following iv administration of the contrast medium to patients and rabbits. To reduce possible hazards of allergic or cardiovascular reactions to nickel, the authors recommend that Ni concentrations in radiographic contrast media should not exceed 10 micrograms per L.