Question

A 58-year-old man with known cirrhosis presents with new confusion and asterixis. His serum ammonia is elevated. There is no fever or focal neurological deficit. What is the most appropriate initial therapy?

Accepted Answer

Oral lactulose titrated to 2 to 3 soft stools per day

Answer

Intravenous mannitol

Answer

High-protein diet

Answer

Immediate intubation and hyperventilation

Answer

Empiric corticosteroids

Practice question

A 58-year-old man with known cirrhosis presents with new confusion and asterixis. His serum ammonia is elevated. There is no fever or focal neurological deficit. What is the most appropriate initial therapy?