Mucomyst protocol for conrast nephropathy

Mucomyst protocol for CT and IV contrast:

For Sr. Creatinine <1.5 gm/dL: routine dose of Ultravist should be given.

For Sr. Creatinine >1.5 gm/dL - <3 gm/dL: Exam should be postponed (the urgency and risks vs benefits should be considered) and prophylaxis as describe below should be employed.

1. N-acetylcysteine (Mucomyst) 600 mg bid on the day before and on the day of IV administration of iodinated contrast.

2. Adequate hydration: (if no CHF or uncontrolled HTN or fluid overload state)

   1. 154 mEq/L NaHCO3 in 5% Dextrose @ 100 mL/hr, beginning 6 – 12 hours before and continuing 4 – 12 hours after the administration of contrast material. OR

   2. In emergent cases, 154 mEq/L NaHCO3 in D5W @ 3 mL/kg of body wt/hr x 1 hour before the exam and continued @ 1 mL/kg of body wt/hr x 6 hrs after the exam.

   3. Visipaque (Iso-osmolal) should be used instead of Ultravist.

American College of Radiology premedication regimen for decreasing the frequency of contrast reactions:

• • Prednisone, 50 mg PO taken 13, 7, and 1 hour prior to contrast administration. Diphenhydramine, 50 mg PO, IV, or IM at 1 hr prior to contrast. Use nonionic low-osmolality agent.

  • Methylprednisone, 32 mg PO at 12 and 2 hours prior to contrast administration. Use of diphenhydramine is optional. Nonionic low-osmolality agent should be used.