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Intervention Recommendation

Recommendation

Gradea

Contrast

   Minimize contrast volume/dose

   Use noniodinated contrast studies

   Use low- or isoosmolar contrast agents

A-1

A-2

A-2

Medications

    Avoid concurrent use of potentially nephrotoxic drugs (e.g., nonsteroidal antiinflammatory drugs, aminoglycosides)

A-2

Normal (0.9%)

saline

     Initiate infusion at least 3 hours prior to contrast exposure and continue 8–24 hours postexposure Infuse at 1 mL/kg/hr up to 150 mL/h, adjusting postexposure as clinically indicated

A-1

Sodium bicarbonate

154 mEq/L

 Initiate infusion at 3 L/kg/h,beginning 1 hour prior to contrast exposure, then continue at 1 mL/kg/h for 6 hours postexposure

B-2

N-acetylcysteine

    Administer 600 mg orally, every 12 hours × 4 doses beginning prior to contrast exposure (i.e., one dose prior to exposure and 3 doses postexposure)

B-1