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Gadolinium is a member of the lanthanide series of the periodic table of elements and is considered a nonessential element. Due to its paramagnetic properties, chelated gadolinium is commonly employed as contrast media for magnetic resonance imaging and computer tomography scanning.
Gadolinium is eliminated primarily by the renal filtration. In healthy subjects with normal renal function, the plasma half-life of gadolinium is approximately 90 minutes. Patients with reduced renal function exhibit an increased gadolinium excretion half-life.
Gadolinium has been associated with the nephrogenic systemic fibrosis in patients with impaired renal function. In this syndrome, prolonged retention of gadolinium is thought to allow the gadolinium cation to dissociate from its synthetic organic chelator and deposit predominantly in the skin, although other organs may be affected as well. These patients are often severely debilitated by progressive skin thickening and tightening. Fibrosis of skeletal muscle, lungs, liver, testes, and myocardium have also been observed, often with fatal results. Because the ionic radius of gadolinium (3+) is similar to that of calcium (2+), it may also deposit in bone.
Three hemodialysis treatments are required to substantially remove gadolinium from patients with impaired renal function; peritoneal dialysis is not effective.
An aid in documenting past exposure to gadolinium-containing chelates
Elevated gadolinium (>3 ng/mL) observed in serum specimens draw >96 hours after administration of gadolinium-containing contrast media is not typical of most patients with normal renal function, indicating impaired elimination of gadolinium or exposure to anthropogenic sources. Patients with reduced renal function who have been exposed to gadolinium may have an increased risk to develop nephrogenic systemic fibrosis.
A normal value is <0.5 ng/mL; the lower limit of the assay's reportable range is 0.1 ng/mL.
Serum gadolinium concentration may be elevated if the specimen is drawn <96 hours of administration of gadolinium-containing contrast media. This elevation is due to residual gadolinium present from contrast media infusion. Elevated serum gadolinium in a specimen drawn <96 hours after contrast media infusion does not indicate risk of nephrogenic systemic fibrosis.
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