Dense Pigmented “Muddy Brown” Casts

Non-contrast CT scan of the head reveals mild cerebral edema with no other acute changes and no evidence of hemorrhage.

Excellent, this is the most appropriate next step for this patient with acute kidney injury on maximal ventilator settings, minimal urine output, and worsening metabolic derangements. The mild cerebral edema makes a continuous modality more appropriate than intermittent hemodialysis in this case.

This patient is already maximally ventilated, leaving little room for fluid administration. Try something else!

While kidney replacement therapy might be the most appropriate step here, there is a better choice than intermittent hemodialysis in this case, particularly with cerebral edema. Pick again!

While a diuretic challenge could be considered, this patient’s condition may be too severe at this point. In addition, this low dose of furosemide is less likely to be effective here.