A patient with a long history of cirrhosis presents with asterixis. He is alert and oriented to…

A patient with a long history of cirrhosis presents with asterixis. He is alert and oriented to person, place, and time. His breath is positive for fetor hepaticus. His abdomen is significant for caput medusae and a positive fluid wave. He has no focal neurologic deficit. His wife states that the patient is very functional at home but is moderately confused and drowsy. Which is the most helpful test to confirm the diagnosis in this patient? a. Serum lactate level b. Serum ammonia level c. Serum iron level d. Serum alkaline phosphatase level e. Serum sodium level

 

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