A 60-year-old woman with advanced cirrhosis and refractory ascites presents with reduced urine output and confusion. Her vitals include BP 85/55 mmHg and HR 110 bpm. Labs reveal a serum creatinine of 2.5 mg/dL, BUN of 60 mg/dL, and sodium of 124 mEq/L. Ultrasound shows normal kidney size and no obstruction. What is the first step in managing this patient’s hepatorenal syndrome?

By usmlevideoss