Your answer
(B) is not the one that we are looking for! (D) is correct!
- Dehydration must be avoided prior to, and during,
coronary angiography, particularly in patients with diabetes and renal
insufficiency. As such, pre-cath IV mannitol has no role in the management
of this patient. Some cardiologists employ IV mannital with a diuretic
at the end of angiography to force diuresis and the rapid transit of
contrast through the kidneys in patients with renal insufficiency. However,
it is imperative that this be associated with appropriate hydration.
- A prospective, randomized, placebo-controlled
study in patients with moderate renal insufficiency confirmed that the
prophylactic oral administration of acetylcysteine (Mucomyst®) at
a dose of 600 mg twice daily along with hydration prevents the reduction
in renal function by a nonionic, low-osmolality radiocontrast agent.
Radiocontrast-induced nephropathy may in part be mediated by
generation of reactive oxygen radicals that cause direct toxic damage
to renal tubular epithelial cell and renal medullary ischemia. Acetylcysteine,
may be beneficial secondary to its antioxidant action.
- IV fenoldopam and "renal doses" of
dopamine have been employed as a an attempt at improving renal perfusion
during and following angiography.
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