A 66-Year-Old Man Comes to the Clinic for a Routine

A 66-year-old man comes to the clinic for a routine physical examination.  He has chronic kidney disease, diabetes mellitus, hypercholesterolemia, and hypertension.  His medications include aspirin, atorvastatin, hydrochlorothiazide, and metformin.  The patient has smoked 2 packs of cigarettes daily for the past 22 years.  His temperature is 37.2 C (99 F), blood pressure is 140/90 mm Hg, pulse is 80/min, and respirations are 12/min.  Physical examination shows a palpable abdominal mass, and auscultation shows a bruit below his umbilicus.  A CT angiogram with intravenous iodinated contrast is performed.  His creatinine level on the day of the scan was 1.8 mg/dL and 2 days later was 2.6 mg/dL.  Which of the following would most likely have prevented this complication in the patient?

A)Hemodialysis treatment after the scan
B)Increased dose of hydrochlorothiazide to promote diuresis
C)Intake of 2 L water by mouth before and after the scan
D)Intravenous saline infusion before and after the scan
E)Oral sodium bicarbonate before and after the scan

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