A 58-year-old man with cirrhosis presents with confusion, sleep reversal, and asterixis. Vital signs show BP 128/76 mmHg, HR 92 bpm, RR 18/min, temperature 37.2°C, and SpO2 98% on room air. Serum ammonia is elevated at 95 μmol/L (normal <35), with INR 2.1 and albumin 2.8 g/dL. Abdominal ultrasound confirms cirrhosis without acute hepatic lesions. He denies recent NSAID use. Which medication most effectively lowers ammonia levels?

1. A)Omeprazole
2. B)Mesalamine
3. C)Loperamide
4. D)Ondansetron
5. E)LactuloseGABARITO