Review Question - QID 214320

A 55-year-old woman presents to the emergency department with altered mental status. She was found in her bedroom by her husband and was minimally responsive. The patient has a history of borderline personality disorder, chronic kidney disease, diabetes mellitus, heart failure, alcoholism, and IV drug abuse. Her temperature is 97.0°F (36.1°C), blood pressure is 120/61 mmHg, pulse is 67/min, respirations are 8/min, and oxygen saturation is 100% on room air. Neurological exam reveals a somnolent patient who arouses to sternal rub. Her pupils are 3 mm and reactive bilaterally. Laboratory studies are ordered as seen below.

Hemoglobin: 12 g/dL
Hematocrit: 36%
Leukocyte count: 5,500/mm^3 with normal differential
Platelet count: 201,000/mm^3

Serum:
Na+: 151 mEq/L
Cl-: 101 mEq/L
K+: 3.9 mEq/L
HCO3-: 17 mEq/L
BUN: 20 mg/dL
Glucose: 110 mg/dL
Creatinine: 1.9 mg/dL
Ca2+: 7.7 mg/dL
AST: 787 U/L
ALT: 541 U/L
Ammonia: 175 µmol/L (normal < 32.0 µmol/L)

Which of the following is the most appropriate treatment for this patient's presentation?