A 55-year-old male with a history of alcoholic cirrhosis is admitted with confusion, asterixis, and lethargy. His ammonia level is elevated. Which of the following is the most appropriate initial pharmacotherapy for this patient's condition?

The correct answer to the question "A 55-year-old male with a history of alcoholic cirrhosis is admitted with confusion, asterixis, and lethargy. His ammonia level is elevated. Which of the following is the most appropriate initial pharmacotherapy for this patient's condition?" is Option B: Lactulose.

The other options — A) Spironolactone, C) Ursodeoxycholic acid, D) Metronidazole — are incorrect for this USMLE Exam Prep question. As explained above: Lactulose is the first-line treatment for hepatic encephalopathy. It works by acidifying the gut lumen, converting ammonia (NH3) to ammonium (NH4+), which is then trapped in the colon and excreted, t…