Helpful Hepatic Hydrothorax Highlights: A Case Taken from the World of Twitter

75-year-old male presents with diuretic refractory hepatic hydrothorax. No overt hepatic encephalopathy but family has noted some episodes of intermittent confusion. He is independent in his activities of daily living. MELD is less than 10.  No history of congestive heart failure, chronic kidney disease or hyponatremia. What do you recommend?