A 56-year-old man with a long history of alcohol use is admitted to the hospital after he had aseizure that was witnessed by his wife. The patient is obtunded, swollen, and jaundiced.Temperature is 36.8°C (98.3°F), pulse rate is 104/min and regular, respirations are 18/min, andblood pressure is 104/62 mmHg. On physical examination, auscultation of the chest showsdiminished breath sounds. Examination of the abdomen shows firmness of the right upperquadrant, palpable hepatomegaly, and protuberance of the umbilicus. Results of laboratorystudies of serum include the following:Creatinine 0.8 mg/dLSodium 108 mEq/LPotassium 3.5 mEq/LBlood urea nitrogen 4 mg/dLWhich of the following is the most appropriate initial management?(A) Emergent hemodialysis(B) Fluid restriction(C) Intravenous administration of 3% saline(D) Intravenous administration of 5% dextrose in water(E) Intravenous administration of diltiazem (Cardizem)
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