Dear doctor(s): I have a patient recently found to have a high AST (15x more than baseline) and SGPt (20x more than baseline), His GTT and Alkaline Phosphatase also elevated. His ammonia level was 93 ( 47). He was noticed to be drowsy, sleepy, weak, which his family said he was not that way before. He is a 92 years veteran, who has cholecystectomy couple years ago and only one kidney (nephrectomy was during WWII) He was admitted to Norman Regional Hospital for 2 full days and returned with a diagnosis of hyperaminitis. After I checked on the book, I found out that was a non-specific hepatitis. But before he was transferred from our VA nursing home, hepatitis profile was done and sent out to private laboratory company, with positive HAV Antibody. Today, another test on IgM was negative. So, I think this hepatitis is not from Hepatitis A which caused positive HAV AB positive, or maybe the HAV infection has occurred about 2 months ago. Request to have instruction about how we should deal with this honorable veteran. Many thanks, jack kao, md, staff physician, Sulphur VA Center, Oklahoma