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AKI sick-day medicines — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentAKI sick-day medicinesGPhC CRA

A 76-year-old man taking ramipril, metformin and naproxen presents with vomiting and diarrhoea for three days. His daughter says he is drowsy and has passed little urine today. What is the most appropriate action?

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Correct answer: D — Refer urgently and advise withholding nephrotoxic or renally cleared medicines pending clinical advice

Vomiting, diarrhoea, oliguria and drowsiness suggest dehydration and possible acute kidney injury. ACE inhibitors, NSAIDs and metformin can become hazardous during acute illness with renal hypoperfusion. Urgent clinical assessment is needed, with medicine withholding guided by local sick-day rules or prescriber advice. Continuing or escalating these medicines could worsen harm.

Reference: NICE CKS Acute kidney injury; BNF