Review Question - QID 214339

A 65-year-old man presents to the emergency department with confusion. The patient is unable to offer a history as he is too confused and is not making sense. His temperature is 98.5°F (36.9°C), blood pressure is 153/89 mmHg, pulse is 95/min, respirations are 18/min, and oxygen saturation is 97% on room air. Physical exam is notable for diffuse yellowing of the patient's skin and sclera. His abdomen is distended and nontender. The patient demonstrates shaking/trembling of his hands when asked to hold them out in front. Dermatologic exam reveals the finding in Figure A. Laboratory values are ordered as seen below.

Hemoglobin: 9.0 g/dL
Hematocrit: 30%
Leukocyte count: 4,500/mm^3 with normal differential
Platelet count: 181,000/mm^3
INR: 2.1

Serum:
Na+: 131 mEq/L
Cl-: 97 mEq/L
K+: 3.5 mEq/L
HCO3-: 25 mEq/L
BUN: 33 mg/dL
Glucose: 99 mg/dL
Creatinine: 1.9 mg/dL
Ca2+: 10.2 mg/dL

Which of the following is the most appropriate initial treatment for this patient?