23rd June 2023

A 65-year-old man with known alcohol-related liver cirrhosis presents to the acute medical take with abdominal distension and yellowing of the skin.

A 65-year-old man with known alcohol-related liver cirrhosis presents to the acute medical take with abdominal distension and yellowing of the skin. His observations were normal; clinical assessment confirmed tense ascites and jaundice alongside other signs of chronic liver disease. There was no clear evidence of gastrointestinal bleeding or infection.

Admission bloods showed an acute kidney injury with a serum creatinine of 190μmol/L from a baseline of 80μmol/L. Urine dip was bland (no blood/protein/leucocytes/nitrites) and urine sodium was <10mmol/L. His urine output is 15-20ml/hr (the patient weighs 80kg).

Which treatment option below is most appropriate for this condition?