Guides · Emergency preparedness
Sick-day rules
Common illnesses (flu, fever, food poisoning, stomach bug) put extra strain on already-stressed kidneys. Some of your regular medicines become risky during illness. Here's the playbook every CKD patient should know — copy it, print it, share it with the family.
The first rule
Don't self-treat. Call your nephrology team.
Even “just a cold” can shift your fluid + electrolyte balance fast in CKD. Your team would rather hear about it on day one than meet you at the ER on day three.
Hold these meds during illness
The British “SADMANS” rule + India-relevant additions. Don't stop anything permanently — just pause until you've been eating, drinking, and feeling normal for 24–48 hours, then restart at your usual dose. Confirm with your nephrologist.
ACE inhibitors (Ramipril, Enalapril, Lisinopril)
Reduce kidney perfusion when dehydrated — can trigger acute injury.
ARBs (Losartan, Telmisartan, Olmesartan)
Same risk as ACEi when dehydrated.
SGLT2 inhibitors (Empagliflozin, Dapagliflozin)
Risk of euglycemic ketoacidosis during illness; pause and hydrate.
Diuretics (Furosemide, HCTZ, Spironolactone)
You're already losing fluid — adding more risks dangerous dehydration and electrolyte swings.
NSAIDs (Ibuprofen, Diclofenac, Naproxen)
Acute kidney injury risk goes way up when sick or dehydrated. Use paracetamol/acetaminophen instead.
Metformin
Risk of lactic acidosis when kidney function dips. Hold during severe illness; restart only after recovery + check labs.
When to call — or go to the ER
Vomiting / diarrhea > 24 hours
You're losing electrolytes you can't replace orally. Call the dialysis unit or nephrologist for advice — and possibly an ER visit.
Fever > 101 °F that won't come down
In a dialysis patient, persistent fever can mean a catheter or fistula infection. Get assessed quickly — do not wait for the next scheduled session.
Swelling, shortness of breath, or rapid weight gain
Fluid overload risk. Skip extra fluids, call your nephrologist. If breathing is hard at rest, go to the ER.
Can't eat or drink for more than 12 hours
Risk of dehydration, hypoglycemia (if diabetic), and electrolyte shifts. Ring your team.
Confusion, slurred speech, or chest pain
Hyperkalemia, low sodium, low sugar — any of these can cause neurological signs. Treat as urgent.
Hydration during illness
- Pre-dialysis CKD: sip plain water, ORS, weak salt-lemon water. Avoid coconut water and fruit juices (too much potassium).
- On dialysis: still inside your fluid budget. Replace electrolyte losses cautiously — do not glug ORS without your dialysis nurse's OK; the sodium adds up.
- Diabetic: check blood sugar more often. Illness raises sugars even if you're not eating.
Before any scan: ask about contrast dye
CT scans with contrast (CECT) can cause contrast-induced acute kidney injury — sometimes permanent in CKD. Tell the radiologist and the referring doctor that you have CKD before the scan is booked. There are often non-contrast alternatives (MRI, ultrasound) that answer the same question.
Useful right now
- 🩺 Generate an emergency wallet card with your stage, meds, and team contacts.
- 💧 Re-check your fluid budget during illness — it may need to be lower if you've been losing more.
- 🧪 Understand the labs your doctor will want after you recover.
This guide is informational. It is not a substitute for advice from your nephrologist or your dialysis unit. If anything feels worse than “a normal cold,” pick up the phone — that's what your team is there for.