The nurse is caring for a patient with severe liver disease. The patient becomes confused and combative. To assess for the presence of hepatic encephalopathy, the nurse would expect the physician to order a serum level of:


•Ammonia is a by-product of protein catabolism. It is normally converted into urea and excreted, but in liver disease, ammonia is not converted and serum levels rise.

•A rise in ammonia levels is toxic to the brain and can cause encephalopathy.

•Uric acid, urea, and lactate are not associated with hepatic encephalopathy.

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