Holly Kelly Ennis
The Dangers of Gadolinium
Magnetic resonance imaging, more commonly known as MRI, is a common diagnostic tool used by physicians to diagnose conditions in the chest, abdomen and pelvis. It uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed images of internal organs, bone, soft tissue and internal body structures to detect abnomalities and injury. To enhance the MRI images to aid in determining a diagnosis, the doctor may order a contrast agent to administered for a more precise picture. A health care provider will administer a Gadolinium Based Contrast Agent (GBCA) through an IV to create higher contrast images.
GBCAs are created from the rare earth metal, gadolinium. They are primarily eliminated from the body through the kidneys within hours after being administered. However, in some patients, gadolinium is retained in the body leading to various, often serious side effects. Additionally, impaired kidney function causes the GBCA to remain in the body for much longer periods of time which can result in the separation of the contrast agent and retention of the toxic gadolinium ion.
When gadolinium is retained in the body, it can have serious consequences – the most serious being an incurable and potentially life-threatening disease known as Nephrogenic Systemic Fibrosis or NSF which is thought to primarily affect patients with severely impaired kidney (renal) function. The primary risk factor for gadolinium retention is having severely impaired renal function, which allows the GBCAs to remain in the body for a much longer time. That increases the risk of the gadolinium ion and ligand separating which results in large quantities of toxic gadolinium being retained in the body. The end result can be NSF. Besides impaired renal function, the stability of the contrast agent that is administered as well as cumulative dosage and high dosage also contribute to retention of gadolinium from the GBCA. The linear GBCAs Omniscan, Optimark and Magnevist are considered to be the least stable and have the potential to cause the greatest harm due to gadolinium retention.
Recently, however, it has been discovered that patients who have normal kidney function can also suffer from gadolinium retention and accumulation. Two documented medical conditions; Gadolinium Depostion Disease and Gadolinium Storage Condition are caused by retained gadolinium. In Gadolinium Deposition Disease or GDD, patients develop painful symptoms within a few hours to up to several weeks after injection of a GBCA. In order to confirm a diagnosis of GDD, patients must display several of the related symptoms.
On May 18, 2018, Dr. Richard Semelka, a noted expert on gadolinium induced medical conditions, revised the primary clinical diagnostic findings for Gadolinium Deposition Disease (GDD) and he described two critical diagnostic features of GDD. First, symptoms of GDD must start within minutes to one month after administration of a gadolinium-based contrast agent (GBCA). Second, the symptoms experienced by the patient after GBCA administration must be new, and not preexisting. Note that a 24-hour gadolinium urine test, performed 30 days or more after an MRI with a gadolinium-based contrast agent (GBCA), is still part of the diagnostic criteria for GDD.
There are now 6 symptoms according to Dr. Semelka as critical diagnostic findings for GDD. He believes it is imperative that individuals have at least 3 of the symptoms, but he prefers to see 5/6 to be certain of the diagnosis.
The 6 main clinical criteria for Gadolinium Deposition Disease, as described by Dr. Semelka are:
1. Intense burning of the skin and skin substrate. Arising in early stage (early on after GBCA): This can be an all over feeling in the body, but often may be localized to the trunk region or distal extremities.
2. Intense boring pain in bones or joints. Arising in early stage (early on after GBCA): This can be any bones or any joints. Often the joints may be peripheral but can also be large joints like the knee or hip. Any bones can have severe point pain, but rib pain is quite distinctive for the disease.
3. Brain fog. Arising in early stage (early on after GBCA): Many terms have been used for this: mental confusion sounds more scientific, but brain fog gets the point across well and succinctly. Brain fog is also a prominent feature of lead toxicity, which is another heavy metal toxicity.
4. Muscle vibrations (muscle fasciculations) and skin pins and needles/tingling (early on after GBCA). These symptoms may represent part of the same process that is causing brain fog. Muscle vibrations/twitching and pins and needles skin sensations generally reflect nerve disease (neuropathy).
5. Head pain (early on after GBCA). Headache is both a very common occurrence and shows tremendous variability. GDD sufferers describe it as a head pain, and unlike any other type of head-ache they have previously experienced. These two properties provide differentiating features for this entity. Some describe it as a burning pain and as an extreme tightness feeling (like a tight bathing cap on their head).
6. Distal arm and leg skin/skin substrate thickening, discoloration, and pain. Arising in the subacute stage (2 weeks +): This is very much like the principal features of NSF, but generally less severe. Instead of woodiness, doughiness; instead of redness, pinkness; instead of extreme joint contractures, stiffness of joints and decreased range of motion. Skin tightness is a feature of GDD as well. This symptom complex should be expected.
Gadolinium Storage Conditioin (GSC) refers to a condition in patients with normal kidney function, who do not have the complete criteria for GDD, but have retained gadolinium in their brain tissue, bones and other body parts. Individuals who take multiple doses of gadolinium, pregnant patients, children and patients with inflammatory conditions are at the highest risks of gadolinium retention.
The most prominent linear GBCAs with the greatest market share are listed below. If you have been diagnosed with a gadolinium based injury, it is important to verify the brand of GBCA used in the MRI:
Dotarem® (gadoterate meglumine) injection
Eovist® (gadoxetate disodium) injection
Gadavist® (gadobutrol) injectionMagnevist® (gadopentetate dimeglumine) injection
MultiHance® (gadobenate dimeglumine) injection
OmniscanTM (gadodiamide) injection
Optimark® (gadoversetamide) injection
ProHance® (gadoteridol) injection
In addition to the symptoms discussed above, gadolinium may also cause the following side effects:
- Difficulty breathing
- Cardiac arrest
- Swelling of the throat or other parts of the body.
- Low blood pressure
- Skin rash or hives
- Abnormal heart rhythms
- High or low blood pressure
- Shortness of breath or difficulty breathing
- Nausea and vomiting
- Mild skin rash or hives
If you or a loved one has been injured by a gadolinium based contrast agent following an MRI or MRA, contact the attorneys at Ennis & Ennis,P.A., for a free consultation at 1-800-856-6405 or visit us online at www.Ennislaw.com.