title: Prevention of contrast nephropathy in critically ill patients using acetylcysteine and theophylline.
abstract: Compared with periprocedural hydration alone, acetylcysteine with hydration significantly reduces the risk of contrast nephropathy in patients with chronic renal insufficiency by 50%. For elective contrast procedures, acetylcysteine should be given in a dose of 600 mg twice daily the day before and on the procedure day. For emergency procedures, a high dose intravenous regimen (150 mg/kg in 500 mL normal saline over 30 minutes immediately before contrast followed by 50 mg/kg in 500 mL normal saline over 4h) is effective. Given the low cost and good side-effect profile of acetylcysteine, it would seem prudent to give this drug with intravenous fluids to all critically ill patients scheduled for intravenous or intraarterial contrast procedures. Theophylline in a dose of 200 mg or 2.5 mg/kg i.v. 30 minutes before contrast may be an effective alternative for emergency procedures. Although its benefit compared with periprocedural hydration alone seems less well established, theophylline is a particularly attractive option for emergency procedures.
authors.affiliation: Department of Internal Medicine, University Hospital of Basel, Basel, Switzerland. chmueller@uhbs.ch
authors.forename: C
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D003287:Contrast Media / Q000009:adverse effects*; D016638:Critical Illness; D004632:Emergency Medical Services; D006801:Humans; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D013806:Theophylline / Q000627:therapeutic use*
chemical_list: D003287:Contrast Media; D010726:Phosphodiesterase Inhibitors; D013806:Theophylline; D000111:Acetylcysteine