ACCS Neurological and Renal Care Flashcards

A patient develops status epilepticus unresponsive to two doses of benzodiazepines. What is the next recommended agent per established US guidelines?

Answer: IV levetiracetam or fosphenytoin

IV levetiracetam or fosphenytoin is the recommended second-line therapy for established status epilepticus after benzodiazepine failure.

Which finding best distinguishes hepatorenal syndrome (HRS) from pre-renal azotemia in a cirrhotic patient?

Answer: No improvement in creatinine after 48-hour albumin challenge and diuretic withdrawal

HRS is diagnosed when creatinine fails to improve after volume resuscitation with albumin and cessation of diuretics, distinguishing it from pre-renal causes.

What is the most common cause of secondary brain injury in the ICU after traumatic brain injury?

Answer: Hypoxia and hypotension

Hypoxia and hypotension are the most significant and common causes of secondary brain injury, dramatically worsening outcomes.

A critically ill patient on CRRT requires anticoagulation. Which agent is preferred to minimize systemic bleeding risk?

Answer: Regional citrate anticoagulation

Regional citrate anticoagulation confines anticoagulant effect to the circuit, minimizing systemic bleeding risk compared to heparin.

Which diuretic class is the first-line pharmacological treatment for acute volume overload in ICU patients with preserved renal function?

Answer: Loop diuretics

Loop diuretics such as furosemide are first-line for acute volume overload due to their potent and rapid natriuretic effect.

In a patient with acute liver failure and grade III hepatic encephalopathy, what ammonia-related intervention is recommended?

Answer: Administer lactulose to reduce intestinal ammonia absorption

Lactulose reduces ammonia production and absorption in the gut, lowering serum ammonia and improving encephalopathy grade.