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Sick Day Rule Triggers Specific — ESENeph MCQ

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EasyAcute Kidney InjurySick Day Rule Triggers SpecificESENeph

A 55-year-old man with CKD G3b on Ramipril and Dapagliflozin develops an upper respiratory tract infection. He continues his medications as he feels well. His GP advises him about sick day rules but he asks when exactly to withhold medications. What are the triggers?

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Correct answer: A — Withhold RASi as the next step

KDIGO 2024 practice point 4.3.2 and NICE AKI sick day rules specify that haemodynamically active medications should be temporarily withheld during acute dehydrating illness to prevent AKI. The triggers are clinical: (1) inability to maintain oral fluid intake; (2) vomiting or diarrhoea; (3) fever with dehydration risk; (4) any condition reducing oral intake. A simple URTI with maintained oral intake does NOT mandate withholding. The key is volume status – if the patient is drinking normally and not losing fluids, medications can usually continue. Patient education should emphasise both WHEN to stop AND WHEN to restart.

Reference: https://guidelines.ukkidney.org