Figure 3. Exploring ‘sick day protocols’ implementation in acute kidney disease.

The sick day protocols comprise several steps. First, identification of sickness. The patient or caregiver should be educated to recognize signs of illness that could lead to further kidney injury, such as vomiting, diarrhea, or fever. Second, identification of dehydration. Dehydration is a common trigger for kidney injury. Patients should be taught to identify signs of dehydration like dry mouth, decreased urine output, and feeling dizzy when standing up. Third, documentation in medical records. All relevant information about the patient’s condition and medication should be documented in their medical record. Fourth, identification and stopping of certain medications. Patients should be advised to temporarily stop certain medications when they are sick. These typically include diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and nonsteroidal anti-inflammatory drugs. However, patients must consult with their healthcare provider before stopping any medication. Fifth, recovery and resuming medications. Once the patient has recovered from the illness and their hydration status is back to normal, they can resume their medications as advised by their healthcare provider.

Readers may also refer to Hall RK et al. [41] for the section on "Safe deprescribing."