SOLVED2745

A 50-year-old male with history of hepatitis C brought to the emergency center by family members for acute mental status changes. The family reports that the patient has been very disoriented and confused over the last few days and has been nauseated and vomiting blood. The family first noticed disturbances in his sleep patter followed by alterations in his personality and mood. On examination, he is disoriented with evidence of icteric sclera. His abdomen is distended with a fluid wave appreciated. He has asterixis and hyperreflexia on neurologic exam. His urine drug screen and ethyl alcohol screen are both negative. A blood ammonia level was noted to be elevated, and all other tests have been normal. What is the most likely cause of the patient’s symptoms?
SCIENCE
HEALTH SCIENCE
NURSING

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