According to his family, he was noted abdomen pain for 2 days. No diarrhea nor fever noted. He visited to our ER. Wheezing dyspnea and paradoxical pattern was noted. The chest x ray showed mild infiltration on the LLL field and acue pul edema. Abdomen fullness with distension noted on the KUB. General weakness with ammonia evevated noted on the lab. data. I