From the Guidelines
Medications that should be temporarily held during acute illness, often referred to as "sick day medications," include ACE inhibitors, ARBs, diuretics, SGLT2 inhibitors, metformin, and NSAIDs, as recommended by the most recent consensus guidelines 1. These medications should be paused when experiencing vomiting, diarrhea, fever, or any condition causing dehydration or reduced oral intake. The primary reason for holding these medications is to prevent acute kidney injury, as they can impair kidney function or worsen dehydration during illness.
- ACE inhibitors and ARBs affect kidney blood flow regulation, while diuretics increase fluid loss.
- SGLT2 inhibitors can increase risk of dehydration and ketoacidosis during illness.
- Metformin may accumulate if kidney function declines, potentially causing lactic acidosis.
- NSAIDs can also worsen kidney function and increase the risk of acute kidney injury. Patients should resume these medications once they are able to maintain adequate hydration and after consulting with their healthcare provider, typically 24-48 hours after recovery from the acute illness, as suggested by recent guidelines 1. It is essential to note that the decision to hold or resume medications should be individualized and based on the patient's specific clinical condition, as emphasized by previous studies 1. In general, holding these medications during acute illness can help prevent morbidity and mortality associated with acute kidney injury and other complications, and is a crucial aspect of managing patients with chronic conditions such as diabetes, kidney disease, and cardiovascular disease 1.
From the Research
Medications to be Held on a 'Sick Day'
The following medications should be considered for withholding on a 'sick day' (day of illness):
- Metformin, especially in patients with severe renal impairment (eGFR < 30 mL/min/1.73m2) or during acute renal deterioration 2, 3
- Sulfonylureas, angiotensin converting enzyme inhibitors, diuretics, angiotensin receptor blockers, non-steroidal anti-inflammatories, and sodium glucose co-transporter 2 inhibitors (SADMANS) due to the risk of acute kidney injury 4
- Medications that can be harmful during acute illness, such as those that improve long-term outcomes but may be detrimental in the short-term 5, 6
Considerations for Sick Day Management
When managing sick days, the following considerations should be taken into account:
- Individualized communication between patients and healthcare providers is crucial for effective sick day management 5
- Tailored sick day practices should be developed based on the patient's specific condition and medication regimen 5
- Healthcare providers should be aware of the potential risks associated with certain medications during acute illness and provide guidance on when to withhold or adjust medications 6, 4, 3