62 y.o man with 40-pack-year smoking Hx. comes to the clinic due to persistent cough. It started 3 months ago and is distinctly worse than his usual smoker’s cough. During this period he had some episodes of hemoptysis and lost 20 lb (9.1Kg). He has No N/V, fever, chills, night sweats, pruritus, seizures, or gait abnormalities. Temp 98.4 F (36.9 C), BP 135/85 without orthostatic drop, and pulse is 75/min. Temporal wasting is evident. The mucous membranes are moist, and the neck is supple without lymphadenopathy. Heart and breath sounds are normal. Abdomen is soft and nontender. No peripheral edema. Patient is oriented. Pupils equal and reactive, no nystagmus. Neuro examination is normal. Labs:
Na 123
K 4
Cl 96
HCO3- 24
BUN 11 mg/dL
Cr 0.9 mg/dL
Glucose 90 mg/dL
Ca 8.9 mg/dL
Albumin 2.9 mg/dL
Which of the following is the best initial treatment for this patient?
A. Albumin infusion
B. Demeclocycline
C. Fluid restriction
D. Hypertonic saline
E. Lactate Ringer solution
F. Normal Saline
G. No additional intervention
Ans:C. Fluid restriction