رجل عمره ٦٢ سنة مصاب بالسكري ويأخذ ميتفورمين، مجدول لقسطرة قلبية بالصبغة غداً بسبب ذبحة غير مستقرة. الكرياتينين اليوم ١٫٩ وكان قبل ٣ أشهر ١٫١، وبوله قليل قليلاً. ما الإجراء الأنسب؟

A 62-year-old diabetic man on metformin is scheduled for contrast coronary angiography tomorrow for unstable angina. Today creatinine is 1.9 mg/dL (1.1 three months ago) and urine output is slightly low. What is the most appropriate action?

1. Cancel the procedure without consulting the physician to protect the kidneys
2. Notify the physician and confirm the hydration plan and temporary metformin hold
3. Restrict fluids before the procedure to avoid overloading the heart
4. Give the usual metformin dose to prevent hyperglycaemia

Answer: B) Notify the physician and confirm the hydration plan and temporary metformin hold. Contrast can injure the kidneys, and with metformin it raises the risk of lactic acidosis. The physician is notified and protocol followed: adequate hydration, a temporary metformin hold and repeat creatinine afterwards.