CorePendium Spotlight: Associated Acute Kidney Injury Contrast

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Greg W. -

Are they Still recommending mucomyst? My facility is still recommending it.

Jessie W. -

Hi Greg! Thanks for your question. This is the answer from our expert:
The quick and dirty is that the only recommended “prophylaxis” is volume expansion with isotonic crystalloid in patients that may be a risk. In reality there is no good data to support any specific prophylaxis. The ACR Contrast manual recommendations on NAC is that the studies are controversial, and “at the current time there is insufficient evidence of its efficacy to recommend its use.”
Hope that helps!
Jessie Werner, MD

Jonathan G. -

at around 7:57, Ryan says "doing everything you can to try and prevent any additional kidney injury..."- what is the "everything you can" besides volume resuscitation and "eliminate other nephrotoxins"? Thanks!

Jessie W. -

I think what Ryan was referring to is avoiding (as much as possible) insults to the kidney. Try to avoid hypotension, nephrotoxic drugs, dehydration, etc. If patients are really sick, try to optimize them as much as possible - fluids, renal dosing of medications, etc.
Hope that helps!

Shwetha H. -

For GFR less than 30, should we give IV fluids (500 cc or 1L of NS or LR) before and after?

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