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Lactic acidosis is more likely to occur in patients who have certain medical conditions, including kidney or liver disease, recent surgery, a serious infection, conditions that may cause a low level of oxygen in the blood or poor circulation such as congestive heart failure, recent heart attack, recent stroke, heavy alcohol use, a severe loss of body fluids dehydration, or X-ray or scanning procedures that require an injectable iodinated contrast drug. Tell your doctor immediately if any of these conditions occur or if you notice a big change in your overall health. You may need to stop taking this medication temporarily. The elderly are also at higher risk, especially those older than 80 years who have not had kidney tests. See also Side Effects and Precautions sections.
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However, it is probably better to use alternative methods of investigation, for example ultrasound in high-risk patients. The common conditions predisposing to high risk of renal toxicity with contrast agents are listed below: в Pre-existing renal failure в Serum creatinine above в Hypovolaemia в Ventricular dysfunction в Hypertension в Dehydration в Nephrotoxic drugs в Diabetes mellitus with generic glucophage xr impairment в Advanced age в Multiple myeloma в Any patient requiring high dose Toxicity is also related to chemical composition of a contrast agent.
This is not completely understood, but appears to be related to protein binding capacity of the molecule. Binding of contrast agent to enzymes in particular can inhibit their activity. For example, inhibition of acetylcholinesterase leads to increased parasympathetic effects. Consequences of this are bronchospasm, a fall in heart rate and hypotension.