The patient is a 55-year-old woman with hepatic sarcoidosis and
   regenerative hyperplasia s/p TIPS [**10/3245**] placed [**1-27**] variceal bleeding
   and portal hypertensive gastropathy s/p TIPS re-do with angioplasty and
   portal vein embolectomy, who was brought to the ED by her husband for
   evaluation after he noted worsening asterixis. While in the waiting room 
   the pt became more combative and then unresponsive. 

   In the ED: VS - Temp 97.9F, HR 115, BP 122/80, R 18, O2-sat 98% 2L NC.
   She was unresponsive but able to protect her airway and so not
   intubated. She vomited x1 and received Zofran as well as 1.5 L NS. Labs
   were significant for K 5.5, BUN 46, Cr 2.2 (up from baseline of 0.8),
   and ammonia of 280. Stool was Guaiac negative. A urinalysis and CXR
   were done and are pending, and a FAST revealed
   hepatosplenomegaly but no intraperitoneal fluid. 
   
   On arrival to the ICU the pt had another episode of emesis. NGT was
   placed to suction and 1.5L bilious material was drained.
   Allergies:
   Cipro (Oral) (Ciprofloxacin Hcl)
   Hives;
   Doxycycline
   Hives; hallucin
   Paxil (Oral) (Paroxetine Hcl)
   hair loss;
   Quinine
   Rash;
   Compazine (Injection) (Prochlorperazine Edisylate)
   muscle spasm;
   Levaquin (Oral) (Levofloxacin)
   tendinitis of t
   Lithium
   Hives;