Review Question - QID 212825

A 55-year-old homeless man presents to the emergency department acutely confused. The patient was found wandering the streets with an abnormal gait. The patient has a past medical history of alcohol and IV drug abuse. His temperature is 98.5°F (36.9°C), blood pressure is 103/61 mmHg, pulse is 120/min, respirations are 16/min, and oxygen saturation is 97% on room air. Physical exam is notable for a poorly kempt man with ataxic gait. Ophthalmoplegia is noted on cranial nerve testing, and he has decreased vibration sensation in the bilateral lower extremity. Dermatologic exam reveals perifollicular hemorrhages, bleeding gums, and many bruises along the patient’s upper and lower extremities. An initial ECG is notable for sinus tachycardia and the patient is given 2L of Ringer lactate. Laboratory values are ordered as seen below.

Hemoglobin: 8.0 g/dL
Hematocrit: 30%
Leukocyte count: 3,500/mm^3 with normal differential
Platelet count: 192,000/mm^3
MCV: 119 fL

Serum:
Na+: 139 mEq/L
Cl-: 100 mEq/L
K+: 4.3 mEq/L
HCO3-: 25 mEq/L
BUN: 20 mg/dL
Glucose: 47 mg/dL
Creatinine: 1 mg/dL
Ca2+: 9.2 mg/dL
Mg2+: 1.2 mEq/L
AST: 82 U/L
ALT: 70 U/L

Which of the following is the best next treatment for this patient?