Sick Day Rules Sepsis RASi SGLT2i — ESENeph MCQ

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EasyAcute Kidney InjurySick Day Rules Sepsis RASi SGLT2iESENeph

A 60-year-old man with CKD G4 on Enalapril and Dapagliflozin is admitted with pneumonia and sepsis. His BP drops to 85/50 mmHg. His creatinine rises from 180 to 420 umol/L. His potassium is 6.2 mmol/L. What should happen to his RASi and SGLT2i?

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Correct answer: D — Temporarily withhold enalapril and dapagliflozin

During acute illness with haemodynamic instability, RASi and SGLT2i impair renal autoregulation: ACEi dilates efferent arteriole and SGLT2i constricts afferent arteriole – both reduce intraglomerular pressure which is beneficial chronically but harmful during acute hypoperfusion. KDIGO 2024 practice point emphasises temporarily withholding haemodynamically active agents during acute illness (sick day rules). This patient needs fluid resuscitation, sepsis management, potassium treatment, and consideration of RRT if AKI is severe. Both agents should be restarted once stable – the long-term benefits of RASi and SGLT2i are not negated by temporary withholding.

Reference: KDIGO 2024 – CKD; NICE AKI 2019 – Sick Day Rules: https://www.nice.org.uk/guidance/ng148/chapter/recommendations