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)