Hepatitis A and E Quiz: Ace Your Exams

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A 67-year-old man was brought to the emergency department by EMS for evaluation of altered mental status. His spouse reports that he has been confused for the last two days. He began experiencing abdominal pain and malaise two weeks ago after returning from a vacation in Mexico. Temperature is 37.0°C (98.6°F), pulse is 92/min, respiratory rate is 22/min, and blood pressure is 138/84 mmHg. On exams the patient is awake and alert but oriented only to the person. Scleral icterus is noted for jaundice of the skin. There is no papilledema. There is abdominal tenderness in the right upper quadrant. His hands display a flapping motion when he extends his arms and cocks his hands back at the wrists. Head CT is normal, and toxicology screen is negative. Lab results are shown below. Which of the following is the best next step in management?  

Laboratory value  
Result
AST
1,702 units/L  
ALT
2,112 units/L  
Total bilirubin  
14.3 mg/dL  
INR
2.2  
Anti-HAV IgM  
positive
Anti-HEV IgM  
positive
HSV PCR  
negative

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