* the Attending Physician Must Order the Hydration Protocol

Guidelines for Hydration for High Risk Patients Receiving Intravenous Contrast

Before the injection of IV contrast (iodinated or gadolinium) for a patient with GFR 30 to 45 the patient should be treated with one of the following options:

* The attending physician must order the hydration protocol.

OPTION 1: Oral  Pre CT o Oral Hydration at 1 extra liter (4 cups) of water within 12 hours of scheduled exam o Bolus 50mEq NaHCO3 over five minutes, intravenous o Wait 30 minutes and scan o Withhold furosemide

 Post-CT o Oral Hydration at 1 extra liter (4 cups) o Out-patient: Bolus 50mEq NaHCO3 over five minutes, intravenous o In-patient: 250ml of 0.9% saline with 50mEq NaHCO3 @ 1ml/kg/hr

OPTION 2: Intravenous

 Pre CT o Out-patient: Bolus 250 ml of 0.45% saline +50mEq NaHCO3 over one hour, intravenous o In-patient: 0.45% or 0.9% saline intravenously at 100 ml/hr, from 12 hours prior to schedule exam o Withhold furosemide

 Post CT o Out-patient: Bolus 50mEq NaHCO3 over five minutes, intravenous o In-patient: 0.45% or 0.9% saline intravenously at 100 ml/hr for 12 hours after the scheduled exam