advancedvalproatehyperammonemiaencephalopathyasterixisammoniaurea cycleL-carnitine
A 64-year-old male on valproate 1500 mg daily for bipolar I disorder presents with confusion, asterixis (liver flap), and lethargy. His valproate level is 85 mcg/mL (therapeutic range 50-125). LFTs are mildly elevated. What lab should the PMHNP order FIRST?