challenges are better guided by hemodynamic parameters obtained by CVC. In
general, crystalloid solutions are preferred over colloid solutions.
- Avoid and discontinue nephrotoxic drugs
All drugs with potential nephrotoxic side effects should be immediately
discontinued. Radiologic tests should avoid the administration of contrast agents.
High osmolality agents such as diatrizoate sodium (Hypaque) and iothalamete
meglumine (Conray) have been associated more commonly with renal
dysfunction. Low osmolality agents are associated with a decreased risk and are
preferred in patients with renal dysfunction.
If needed, intravenous (IV) contrast agents should be used at least 5 days apart.
Appropriate hydration with isotonic bicarbonate solution (3 ampules of Sodium
Bicarbonate [50 meq/ampule] in 850 cc D5W) at a rate of 3 mL/kg IV one hour
before the procedure and 1 mL/kg IV six hours after the procedure. Normal saline
(0.9% NaCl) at 1 mL/kg/hr for 12 hours pre-procedure and 12 hours post-
procedure is another commonly used protocol.[33]
Acetylcysteine (Mucomyst) have questionable benefits in preventing contrast-
induced nephropathy. When used, give 600 mg PO twice daily in adults. There is
no consensus on acetylcysteine dosing in children.
- Adjust medication dosages according to GFR
Dosage of medications should be individually adjusted according to the
patient’s GFR. Reducing drug doses and prolonging the dosing intervals are two
recommended strategies in patients with established renal failure.
- Low-dose Dopamine?
Low dose dopamine (<5μg/kg/min) was considered for a long time an
adjuvant therapy in patients with compromised renal function due to its renal