skip to main content

SADMANS Sick Day Rules — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

EasyAcute Kidney InjurySADMANS Sick Day RulesESENeph

A 55-year-old man with CKD G3b on Ramipril, Dapagliflozin, and Finerenone develops an acute dehydrating illness (gastroenteritis). He calls his GP. Which of his regular medications does the SADMANS mnemonic apply to?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Ramipril (ACEi), Dapagliflozin (SGLT2i), and Finerenone (MRA) should all be temporarily withheld during acute illness per the SADMANS principle

The SADMANS mnemonic identifies drugs to temporarily withhold during acute dehydrating illness to prevent AKI: Sulfonylureas, ACEi (Ramipril), Diuretics/DRIs, Metformin, ARBs, NSAIDs, SGLT2i (Dapagliflozin). Finerenone (MRA – 'M' can also encompass MRAs in some versions, or it falls under the general principle of withholding agents that worsen hyperkalaemia/AKI). KDIGO 2024 practice point 4.3.2 emphasises clear communication about which medications to stop AND when to restart them.

Reference: KDIGO 2024 – CKD (Practice Point 4.3.2); NICE AKI Pathway 2019