Prevention

Use low-osmolality contrast media ^a  particularly for high-risk patients

• with pre-existing renal impairment ^a  
• with diabetes ^b  
• undergoing angiography ^b  

Give high-risk patients pre- and post-contrast

• 0.45% saline (1 mg/kg/hr for 12 hours) ^c
• acetylcysteine 600 mg twice daily ^a

Avoid

• furosemide ^a  
• mannitol   ^d  
• metformin ^d

Antibiotics:  aminoglycosides

Avoid aminoglycosides ^d in patients with 

• renal dysfunction (creatinine clearance >60ml/ min or rising creatinine) 
• shock 

unless there is no good alternative. ^d

Estimate your patient's renal function when contemplating aminoglycoside treatment. ^d

Creatinine clearance > 60mL/min

• Give aminoglycosides once a day (most commonly 4.5mg/kg of dose-determining weight)
• Monitor levels during therapy and adjust dose intervals
• Measure a trough level prior to the third dose. ^d If  > 2 µg/l, increase the dose interval or reduce the dose. ^d
• Monitor creatinine levels during therapy (every 2-3 days minimum, more frequently if pre-existing renal dysfunction, shock or critically ill). ^d

Creatinine clearance < 60 ml/min

• Adjust the dose or the dose interval according to the level of dysfunction and according to the clinical circumstances.
• Monitor levels during therapy and adjust dose intervals
• Measure a trough level prior to the second dose. ^d If  > 2 µg/l, increase the dose interval or reduce the dose. ^d
• Monitor creatinine levels during therapy (every 2-3 days minimum, more frequently if pre-existing renal dysfunction, shock or critically ill). ^d

Aminoglycoside toxicity can manifest days after the last dose ^d

Critically ill

There is no clear benefit using from 

• albumin ^d
• prophylactic dopamine ^a