CJEM Articles: renal failure

Displaying 1-3 of 3 results

  • N-acetylcysteine for radiocontrast-induced nephropathy: Potential role in the emergency department?
    July 2004 6 4
    Elaine Chong, Peter J. Zed

    Objective: To systematically review the efficacy and safety of N-acetylcysteine (NAC) for the prevention of radiocontrast-induced nephropathy (RIN), and to discuss its potential role in the emergency department.

    Methodology: We conducted a search of MEDLINE (from 1966 to December 2003), PubMed (1966 to December 2003) and EMBASE (1988 to December 2003) for English-language, prospective, randomized, controlled trials in humans using the search terms N-acetylcysteine, acetylcysteine, radiopharmaceuticals, contrast media, and kidney failure (acute).

    Results: Five trials support and 4 trials refute the hypothesis that NAC helps prevent RIN. In 7 of 9 trials, oral NAC was administered twice daily for 2 days, on the day before and on the day of the radiocontrast study -- a regime not feasible for emergent situations. More recent trials suggest that adequate hydration and lower volumes of radiocontrast, rather than NAC, are more effective ways to prevent RIN.

    Conclusion: Although further study may be indicated, current evidence does not suggest that NAC has a role in the emergency prevention of RIN.

  • Diabetic ketoacidosis in the dialysis-dependent patient: two case reports and recommendations for treatment
    July 2004 6 4
    Anthony M. Herd, Jamie Blicker, Joanne Talbot
  • Anticholinergic visual hallucinosis from atropine eye drops
    July 1999 1 2
    Andrew G. Bishop, John M. Tallon

    A 37-year-old man with type I diabetes mellitus and chronic renal failure presented to the emergency department complaining of hallucinations. He was 5 days postoperative for left pars plana vitrectomy and intra-ocular lens implantation and had been taking ophthalmic atropine, tobramycin and prednisolone. He had presented 5 months earlier, on the same ophthalmic medications, with postoperative hallucinations after a right pars plana vitrectomy. Visual hallucinations are a major side effect of anticholinergic poisoning. Ophthalmic instillation of atropine has been documented to cause many central nervous sytstem symptoms, including hallucinations.