Type with doses

Appropriate treatment and medication for this 64-year-old male with decompensated liver cirrhosis, renal impairment, recurrent hematuria, ascites, bilateral lower limb edema, and recent gastrointestinal bleeding include:

• Diuretics: Spironolactone starting at 100 mg once daily, titrated up to 400 mg daily as tolerated, combined with furosemide starting at 40 mg once daily, titrated up to 160 mg daily, to manage ascites and peripheral edema under specialist supervision.
• Correction of coagulopathy: Vitamin K 10 mg IV or orally once daily for 3 days if indicated by prolonged PT/INR, and transfusion of fresh frozen plasma as needed based on bleeding risk and specialist advice.
• Management of anemia and thrombocytopenia: Transfusion of packed red blood cells and platelets as clinically indicated, with careful monitoring due to underlying liver disease.
• Renal impairment: Avoid nephrotoxic drugs; consider albumin infusion and vasoconstrictors (e.g., terlipressin 1 mg IV every 4–6 hours) if hepatorenal syndrome is suspected, under specialist guidance.
• Gastrointestinal bleeding prevention: Non-selective beta-blockers such as propranolol starting at 20 mg twice daily, titrated to reduce heart rate by 25%, to reduce portal hypertension; proton pump inhibitors (e.g., omeprazole 20 mg once daily) if indicated.
• Diabetes management: Adjust antidiabetic medications considering renal and hepatic function; insulin may be preferred if oral agents are contraindicated.
• Infection management: Empirical broad-spectrum antibiotics if infection suspected, guided by cultures and local protocols.
• Urological evaluation: No specific medication for hematuria without diagnosis; referral for cystoscopy and imaging is essential.

All medications should be initiated and adjusted under specialist supervision with close monitoring for adverse effects and efficacy.