(M2.EC.17.4872) A 72-year-old man presents to the emergency department for a change in his behavior. The patient's wife called 911 and he was brought in by emergency medical services. She noticed that he seemed somnolent and not very responsive. The patient has a past medical history of type II diabetes, obesity, osteoarthritis, and migraine headaches. His current medications include naproxen, insulin, atorvastatin, metformin, ibuprofen, omeprazole, and fish oil. His temperature is 99.5F (37.5C), blood pressure is 170/115 mmHg, pulse is 80/min, respirations are 19/min, and oxygen saturation is 98% on room air. On physical exam, the patient is somnolent and has a Glasgow Coma Scale of 11. Cardiac and pulmonary exams are notable for bibasilar crackles and a systolic murmur that radiates to the carotids. Neurological exam is deferred due to the patient's condition. Laboratory values are shown below.Hemoglobin: 12 g/dLHematocrit: 36% Leukocyte count: 9,500 cells/mm^3 with normal differential Platelet count: 199,000/mm^3 Serum: Na+: 144 mEq/L Cl-: 98 mEq/L K+: 4.0 mEq/L HCO3-: 16 mEq/L BUN: 44 mg/dL Glucose: 202 mg/dL Creatinine: 2.7 mg/dL Ca2+: 9.2 mg/dL AST: 12 U/L ALT: 22 U/LThe patient is started on IV fluids. Which of the following represents the best next step in management?
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