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Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 55-year-old man with no significant medical history returns for follow-up of a fasting blood glucose (FBG) of 110 mg/dL. His mother had a myocardial infarction at age 52. He weighs 90 kg and his body mass index is 35 kg/m2. His repeat FBG is 160 mg/dL and hemoglobin A1c (HbA1c) is 7.0%. He is started on metformin but is lost to follow-up. Two years later, his HbA1c is 7.6% despite maximal metformin usage, so the patient is started on glyburide. Three months later, his HbA1c is 7.3% while on both medications, and subsequently prescribed glargine and aspart. Three months later, he is brought by his wife to the emergency department for evaluation of altered mental status. His electronic medical record notes that he was started on nitrofurantoin recently for an urinary tract infection. He is disoriented to place and time. His temperature is 99°F (37.2°C), blood pressure is 90/60 mmHg, pulse is 130/min, respirations are 26/min. His basic metabolic panel is shown below:

Serum:
Na+: 119 mEq/L
Cl-: 90 mEq/L
K+: 4.2 mEq/L
HCO3-: 24 mEq/L
BUN: 25 mg/dL
Glucose: 1,400 mg/dL
Creatinine: 1.9 mg/dL

His urine dipstick is negative for ketones. A peripheral intravenous line is established. What is the best initial step in management?
assistant
Lactated ringer's solution