Parameters:
(1) number of risk factors for contrast-induced nephropathy (CIN)
(2) body weight in kilograms
(3) availability of an alternative imaging method that does not require contrast material
If the person has >= 1 risk factors for contrast-induced nephropathy and if an alternative imaging method is available, then use the alternative imaging method.
All patients with >= 1 risk factor for CIN should receive:
(1) intravenous hydration before the procedure
(2) the minimum volume of an iso-osmolar or low-osmolar contrast agent
(3) intravenous hydration after the procedure
Intravenous hydration consists of:
(1) intravenous fluid administration - one of the following:
(1a) normal saline infused at 1 mL per kg per hour for 6-12 hours before and after the procedure
(1b) 5% dextrose and water (D5W) plus sodium bicarbonate 154 mEq/L infused at 3 mL per kg for 1 hour before AND 1 mL per kg per hour for 6 hours after the procedure
(2) monitoring for fluid overload
(3) monitoring for metabolic alkalosis (if sodium bicarbonate infused)
If the patient has >= 2 risk factors then consider one of the following antioxidants:
(1) N-acetylcysteine (NAC) 600 - 1,200 mg po bid on day before and on day after the procedure.
(2) ascorbic acid (vitamin C), 3 grams po 2 hours before procedure and 2 grams po bid on the day after the procedure.
