Soru

A 58-year-old woman is brought to the emergency department by her family due to increased confusion and severe abdominal pain over the past 24 hours. She has a history of decompensated alcoholic cirrhosis and was recently discharged after treatment for esophageal varices. Her home medications include lactulose, rifaximin, spironolactone, furosemide, and propranolol.

Temperature is 38.4°C (101.1°F), blood pressure is 86/54 mmHg, pulse is 114/min, and respirations are 22/min. Physical examination reveals scleral icterus, spider angiomas, and a markedly distended abdomen with a positive fluid wave. There is diffuse, severe abdominal tenderness to palpation without rebound or guarding. Asterixis is present.

Laboratory studies show:
Leukocyte count: $14,500/\mu L$
Platelet count: $88,000/\mu L$
Serum sodium: $132 \text{ mEq/L}$
Serum potassium: $5.3 \text{ mEq/L}$
Serum creatinine: $2.1 \text{ mg/dL}$ (baseline $1.0 \text{ mg/dL}$)
Blood urea nitrogen: $52 \text{ mg/dL}$

Diagnostic paracentesis yields turbid ascitic fluid with a total nucleated cell count of $1,200/\mu L$ and $85\%$ neutrophils ($1,020 \text{ PMNs}/\mu L$).

Which of the following pharmacologic interventions are indicated for this patient? (Select all that apply)