Profound hypoglycemia after intravasation of cystogram: A previously unreported complication of cystogram

Contrast imaging studies are instrumental in the evaluation and management of the patient; however, associated complications and side effects remain largely unelucidated. We present a patient in whom inadvertent intravasation of Cystografin (dilute diatrizoate meglumine injection, 18%) was complicated by profound hypoglycemia during a routine cystogram. A 58-year-old male presented for evaluation of a long-standing presumed urinary fistula that developed after a right herniorrhaphy performed 20 years previously. Past medical history was pertinent for diabetes mellitus, but he was taking no medications for diabetes. Approximately 60 minutes after a cystogram, the patient became unresponsive and profoundly hypoglycemic with a blood glucose concentration of 10 mg/dL. He was transferred to the intensive care unit. Despite 10 ampules of 50 g dextrose (D50W) and a constant dextrose (D10W) infusion, he remained hypoglycemic for 36 hours. The cystogram demonstrated inadvertent placement of the Foley catheter into the body of the prostate and the passage of contrast into the prostatic venous drainage. The prolonged hypoglycemia in our patient illustrates a near fatal reaction during a simple radiographic procedure. Although the pathophysiology of intravasation has not been well-defined, this potentially devastating outcome of accidental intravasation clearly warrants further observation.