Mental status and fluctuating attentiveness

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Reference no: EM133804866

Question

A 43-year-old woman presents with altered mental status and fluctuating attentiveness. She has a medical history of alcohol use disorder and cirrhosis managed with spironolactone, lactulose, rifaximin, and metoprolol. She underwent a transjugular intrahepatic portosystemic shunt procedure two months ago. She continues to drink alcohol, but she has not had an alcoholic beverage in four days. Systolic blood pressure is 160 mm Hg, pulse is 114 beats per minute, and Clinical Institute Withdrawal Assessment for Alcohol-Revised score is 21. Ammonia level is 98 µ/dL. Which of the following findings on physical examination is most specific to hepatic encephalopathy? Asterixis Hypoactive deep tendon reflexes Lateral rectus palsy Nystagmus.

Reference no: EM133804866

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