During vomiting, diarrhoea, fever with poor intake or any dehydrating illness, kidney function can fall quickly. Established practice is to advise temporary withholding of drugs that reduce renal perfusion or accumulate when function falls, and restarting them after 24 to 48 hours of normal eating and drinking.
The usual list is ACE inhibitors and angiotensin receptor blockers, diuretics, SGLT2 inhibitors, metformin and NSAIDs. Agree the list with the patient in writing, individually.
- Give a written list of medicines to pause during dehydrating illness.
- Include ACE inhibitors, angiotensin receptor blockers, diuretics, SGLT2 inhibitors, metformin and NSAIDs where prescribed.
- Tell patients to restart after 24 to 48 hours of normal eating and drinking.
- Advise seeking help if illness lasts more than a couple of days.
- Individualise the list for each patient.
Why it matters
Acute kidney injury during intercurrent illness is often preventable.
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