Approach to lower limb edema Quiz: Ace Your Exams

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A 33-year-old man presents to the emergency department due to severe shortness of breath and fatigue. The symptoms began four days ago after a mild upper respiratory infection. Past medical history is unremarkable. The patient drinks 3 beers per day. Temperature is 36.5 ºC (97.7 ºF), pulse is 108/min, blood pressure is 100/72, respiratory rate is 22/min, and oxygen saturation (SpO2) is 88% on room air. On physical examination, the patient has labored breathing. The jugular venous pulse is elevated. On auscultation, there are crackles throughout both lungs and an S3 heart sound is heard. There is 2+ pitting edema bilaterally up to the knees. Mental status examination is normal. Laboratory analyses are shown below. Which of the following is the best next step in management?
 
Laboratory Test  
Value
Reference Range  
Serum sodium  
130 mEq/L  
136-146 mEq/L  
Serum creatinine  
2.8 mg/dL  
0.6-1.2 mg/dL  
Serum AST  
228 U/L  
8-40 U/L  
Serum ALT  
112 U/L  
8-40 U/L  
Serum total bilirubin  
3.8 mg/dL  
0.1-1 mg/dL  
Serum INR  
1.0  
≤1.1  
Urine protein/creatinine  
0.6  
<0.2  

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