Pharmacology - A patient is in renal failure, which is the material when given

Pharmacology

1. A patient is in renal failure, which is the material when given along with contrast that is least harmful:
A. Half normal saline
B. Fenoldopam
C. N-acetyl cysteine
D. ?

References:
1. http://www.orthosupersite.com/view.aspx?rid=18709
2. http://findarticles.com/p/articles/mi_m0ICF/is_4_34/ai_n27379688/
3. http://jasn.asnjournals.org/content/15/2/251.full
4. http://www.biomedcentral.com/1741-7015/5/32

Answer: A. Half normal saline

Explanation
The answer would most probably be A. The reasons are:
• Fenoldopam’s role in contrast induced nephropathy (CIN) is questionable
• A meta-analysis has ruled out use of NAC in CIN
• The mainstay of prophylaxis for CIN is volume supplementation with normal saline or half normal saline. It has been shown that normal saline is superior to half normal saline and also that volume supplementation is superior to NAC.
• There are no studies comparing half normal saline with NAC. However, in all trials done, NAC was given along with volume supplementation and not alone.

Hence, volume supplementation is the most effective and safest. In the given choices, it would be half normal saline. If the choice D is normal saline, then the answer would be normal saline.