A 62 year old man is admitted to the hospital from the doctor’s office with altered mental status. Past medical history

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A 62 year old man is admitted to the hospital from the doctor’s
office with altered mental status. Past medical history reveals
cirrhosis resulting from hepatitis C, esophageal varices, hepatic
encephalopathy, and ascites. The patient reports missing his dose
of lactulose the two previous days. Muscle wasting is noted in the
form of squared shoulders, prominent clavicle, temporal wasting,
and thin extremities. He has 3+ edema in his lower extremities and
protuberant abdomen from ascites. His abnormal laboratory values on
admission included elevated liver function enzymes and total
bilirubin, sodium 127 mEq/L (LOW), glucose 68 mg/dL (LOW).
Anthropometric data include: height 177.8 cm; usual (dry) weight
71.8 kg; current body weight 78.4 kg.