A patient with a history of alcoholism and liver cirrhosis presents to the ED with diffuse abdominal pain, rigidity, and rebound tenderness. Labs show elevated WBC count and a lactate of 4 mmol/L. The patient has hypotension and tachycardia despite fluid resuscitation. Which immediate intervention is MOST appropriate for this patient?
Administer intramuscular analgesics for pain relief.
Perform an immediate diagnostic paracentesis.
Start the patient on oral lactulose for hepatic encephalopathy.
This patient is showing signs of septic shock likely secondary to spontaneous bacterial peritonitis (SBP), a common and severe complication of cirrhosis. SBP should be suspected in patients with cirrhosis who present with signs of systemic infection and peritoneal inflammation. The elevated lactate indicates a state of tissue hypoperfusion that accompanies septic shock. Immediate initiation of broad-spectrum IV antibiotics is crucial to manage the suspected infection and should not be delayed for diagnostic paracentesis, which, while important for confirming the diagnosis, does not take precedence over the initiation of antibiotics in a hemodynamically unstable patient.
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Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
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