American Board of Internal Medicine (ABIM) Certification Practice Exam

In cirrhotic patients with spontaneous bacterial peritonitis (SBP), when should albumin be administered?

1. When serum creatinine is above 1 mg/dL

2. When bilirubin is below 4 mg/dL

3. When blood urea nitrogen is below 30 mg/dL

4. When serum creatinine is below 1 mg/dL

The correct answer is: When serum creatinine is above 1 mg/dL

In the context of cirrhotic patients with spontaneous bacterial peritonitis (SBP), the administration of albumin is primarily indicated to improve renal function and outcomes in individuals at risk of developing acute kidney injury. The specific guideline suggests that albumin should be administered when serum creatinine levels are above 1 mg/dL. The rationale behind this recommendation is that elevated serum creatinine in the context of SBP reflects a degree of renal compromise, often associated with a higher risk of developing acute kidney injury. By administering albumin, it helps to expand plasma volume, improve renal perfusion, and potentially mitigate the risk of kidney deterioration. This intervention has been shown to enhance survival and reduce the incidence of renal impairment in these patients. In contrast, the other options do not align with current clinical guidelines. For instance, bilirubin levels below 4 mg/dL or blood urea nitrogen levels below 30 mg/dL do not trigger the same level of concern regarding renal function as elevated serum creatinine does, hence they are not indicators for albumin administration in the setting of SBP. Similarly, administering albumin when serum creatinine is below 1 mg/dL does not address the urgent need for intervention, as the primary concern occurs when