A 56-year-old man with a long history of alcohol use is admitted to the hospital after he had a seizure 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, and blood pressure is 104/62 mmHg. On physical examination, auscultation of the chest shows diminished breath sounds. Examination of the abdomen shows firmness of the right upper quadrant, palpable hepatomegaly, and protuberance of the umbilicus. Results of laboratory studies of serum include the following: Creatinine 0.8 mg/dL Sodium 108 mEq/L Potassium 3.5 mEq/L Blood urea nitrogen 4 mg/dL Which 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)

A 56-year-old man with a long history of alcohol use is admitted to the hospital after he had a seizure 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, and blood pressure is 104/62 mmHg. On physical examination, auscultation of the chest shows diminished breath sounds. Examination of the abdomen shows firmness of the right upper quadrant, palpable hepatomegaly, and protuberance of the umbilicus. Results of laboratory studies of serum include the following: Creatinine 0.8 mg/dL Sodium 108 mEq/L Potassium 3.5 mEq/L Blood urea nitrogen 4 mg/dL Which 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). A 56-year-old man with a long history of alcohol use is admitted to the hospital after he had a
seizure 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, and
blood pressure is 104/62 mmHg. On physical examination, auscultation of the chest shows
diminished breath sounds. Examination of the abdomen shows firmness of the right upper
quadrant, palpable hepatomegaly, and protuberance of the umbilicus. Results of laboratory
studies of serum include the following:
Creatinine 0.8 mg/dL
Sodium 108 mEq/L
Potassium 3.5 mEq/L
Blood urea nitrogen 4 mg/dL
Which 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)

A 56-year-old man with a long history of alcohol use is admitted to the hospital after he had a seizure 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, and blood pressure is 104/62 mmHg. On physical examination, auscultation of the chest shows diminished breath sounds. Examination of the abdomen shows firmness of the right upper quadrant, palpable hepatomegaly, and protuberance of the umbilicus. Results of laboratory studies of serum include the following: Creatinine 0.8 mg/dL Sodium 108 mEq/L Potassium 3.5 mEq/L Blood urea nitrogen 4 mg/dL Which 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)