Spontaneous bacterial peritonitis Quiz: Ace Your Exams
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A 57-year-old man is brought to the emergency department for fever and confusion. His partner states that he has been increasingly confused over the past 24 hours and appears more lethargic than usual. The patient has a past medical history of cirrhosis due to untreated hepatitis C. His current medications are furosemide and spironolactone. Temperature is 38.5℃ (101.3℉), pulse is 102/min, respiratory rate is 14/min, blood pressure is 90/58 mmHg, and oxygen saturation is 99% on room air. The patient is oriented to self and place, but not to month or year. Abdominal examination shows moderate ascites with diffuse tenderness to palpation. Laboratory tests are shown below. Diagnostic paracentesis shows a neutrophil count of 325/μL. Which of the following is the best next step in management?
| Laboratory Test | Result |
| Hemoglobin | 11.1 g/dL |
| Leukocyte count | 5,500/μL |
| Platelet count | 110,000/μL |
| Creatinine | 1.4 mg/dL |
| BUN | 34 mg/dL |
| Total bilirubin | 3.9 mg/dL |
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