A 62-year-old man with a known history of decompensated cirrhosis secondary to alcohol use disorder is brought to the emergency department by his son. The son reports his father has had increasing confusion, lethargy, and a low-grade fever for two days. He also notes his father's abdomen seems more distended and tender. His last alcoholic drink was six months prior. His medical history is significant for esophageal varices with no recent bleeding and ascites managed with spironolactone and furosemide. He is up to date on his hepatocellular carcinoma screening. Initial laboratory studies are as follows:

PT/INR: 17.5 seconds / 1.8 (11-13.5 seconds / 0.8-1.1)

Na⁺: 128 mEq/L (136-146)

K⁺: 4.8 mEq/L (3.5-5.1)

Cl^-: 94 mEq/L (98-107)

BUN: 35 mg/dL (7-20)

Creatinine: 1.4 mg/dL (0.6-1.2)

Glucose: 98 mg/dL (70-100)

Total Protein: 5.5 g/dL (6.0-8.3)

Albumin: 2.2 g/dL (3.5-5.0)

Total Bilirubin: 4.5 mg/dL (0.1-1.2)

AST: 110 U/L (10-40)

ALT: 65 U/L (7-56)

Ammonia: 95 µmol/L (11-32)