A 61-year-old man was transferred from a rural hospital for investigation and management of anuric acute kidney injury. His medical history included recurrent unprovoked deep vein thrombosis, hyperlipidaemia, alcohol use (3–4 cans of beer/day) and gastritis. His usual drugs were apixaban, fenofibrate and pantoprazole.
Two weeks before presenting to the rural hospital, the patient was prescribed ciprofloxacin for a urinary tract infection with Pseudomonas aeruginosa. At the time of dispensing he was advised to take the ciprofloxacin ‘on an empty stomach’. In response to this advice, the patient decreased his overall daily intake to occasional toast and 3–4 cans of beer. At this time the patient also developed twice-daily watery stools, but he adhered to what he understood to be a food and fluid restriction and continued taking his medicines.
The patient presented to the rural hospital following a fall, complaining of abdominal distension and diarrhoea. Initial observations and investigations found that he was haemodynamically stable with acute kidney injury (serum creatinine over 500 micromol/L) and decreased urine output. The anuria persisted despite fluid resuscitation so the patient was transferred to a specialist centre where his renal function slowly recovered.
Clear and patient-centred communication reduces misunderstanding and confusion and improves adherence. Patient education is key in this process and may include both verbal and written information. An explanation of why ciprofloxacin is taken separately from food, but not water, may have helped in this case.
Darren Roberts is Chairman of the Editorial Executive Committee of Australian Prescriber.
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