11-19-2007, 08:26 PM
28. A 56-year-old man who is alcohol-dependent is admitted to the hospital because of fever, encephalopathy and increasing abdominal girth. The patient has no family and has been living on the street. An abdominal paracentesis is consistent with spontaneous bacterial peritonitis, which is treated with antibiotic therapy. During the next 10 days, the patient's renal function deteriorates and his serum creatinine concentration increases to 11.3 mg/dL, with a serum urea nitrogen (BUN) concentration of 144 mg/dL. He becomes progressively more obtunded, develops respiratory failure and is intubated. He requires vasopressors to maintain his blood pressure. There is general agreement from the gastrointestinal and renal services that he will not recover and that further treatment, including dialysis, is futile. The patient is thrashing about in bed, moaning and grimacing periodically. Which of the following is the most appropriate next step in management?
A
) Do a liver biopsy to identify the cause of the patient's liver failure
B
) Initiate lactulose treatment to reduce his encephalopathy
C
) Initiate analgesic therapy to palliate the patient's apparent discomfort
D
) Stop all antibiotic therapy to reduce the chance of further renal toxicity
E
) Stop all medical treatment
A
) Do a liver biopsy to identify the cause of the patient's liver failure
B
) Initiate lactulose treatment to reduce his encephalopathy
C
) Initiate analgesic therapy to palliate the patient's apparent discomfort
D
) Stop all antibiotic therapy to reduce the chance of further renal toxicity
E
) Stop all medical treatment