A case of severe acute kidney injury secondary to the combination of traveler’s diarrhea, profound dehydration and concomitant angiotensin-II inhibitor use.

Abstract

Renin-angiotensin system inhibitors (RAS-I) are commonly used for hypertension and for renal and cardiac protective effect. It is also important to have sick-day rules for RAS-I to avoid development of acute kidney injury (AKI). We experienced a case of a man in his 70s who presented with AKI (Cr peak 13.4mg/dL) secondary to the combination of traveler’s diarrhea, profound dehydration and concomitant RAS-I use. He recovered uneventfully with conservative management to Cr 2.9. This case is educational to acknowledge the importance of implementing sick-day rules for RAS-I to emergency physicians and to the patients.