February 21, 2020
In the GIM clinic today, I saw an elderly patient for follow-up of her acute kidney injury on chronic kidney disease due to initiation of Lasix for management of CHF. She had a creatinine rise from 140s to 200s. Her creatinine clearance was less than 30. As she was euvolemic on exam, she was discontinued off her Lasix. Her ACE inhibitor and SGLT2 inhibitor were also temporarily discontinued.
After reading more about diabetes medications for renal insufficiency, I would have switched her from sitagliptin to linagliptin instead of fully discontinuing this as she would benefit from better blood glucose control given that her A1c was not at target.
As a big fan of mnemonics, one of the ones that I often go to when counselling patients about sick day medications is SADMANS:
S: sulfonylureas
A: ACE inhibitors
D: diuretics
M: metformin
A: ARBs
N: NSAIDs
S: SGLT2 inhibitors
-JT-
Reference(s):
https://www.diabetes.ca/DiabetesCanadaWebsite/media/Health-care-providers/2018%20Clinical%20Practice%20Guidelines/Appendix-8-sick-day-medication-list.pdf?ext=.pdf
https://guidelines.diabetes.ca/cpg/chapter13
https://care.diabetesjournals.org/content/31/Supplement_2/S194
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