Question category: Gastroenterology
A 50 year old female with known alcohol related liver disease is noted by her husband to be confused and disorientated. She has been recently commenced on furosemide and spironolactone for recurrent ascites. Over the last few days she has complained of increased urinary frequency and dysuria. On examination there was evidence of ascites, which were not tense, and asterixis. Bloods revealed acute renal failure and deranged LFTs. What is the most likely cause of her confusion?