This is a @AGE@ @SEX@ with a presentation consistent with acute hepatic encephalopathy. Exam notable for stigmata of cirrhosis and portal hypertension. Likely precipitant: increased ammonia levels (GIB // excess protein // infection // electrolyte and/or acid base disturbance// constipation) // dehydration (vomiting, diuretic use) // medication induced (opioids, benzodiazepine overdose or withdrawal // ETOH use.*** Low suspicion for acute GIB, including evidence of life threatening hemorrhage. Low suspicion for acute infection including SBP (no fevers, abdominal pain). Presentation not consistent with other acute, emergent causes of altered mental status (including but not limited to renal failure, ICH) at this time.

Plan: labs, LFTs, ammonia level, PT/INR, UA, CXR, CT brain***, diagnostic paracentesis***, serial reassessment