Inclusion Criteria:  patients with confirmed diagnosis of cirrhosis (age >18 years ) who will be admitted to internal medicine department or will be admitted to intermediate care unit  willing and agree to be included in the study  Exclusion Criteria:  patients without evidence of cirrhosis  cirrhotic patients whom -younger than 18 years old  have diabetic ketoacidosis with acute coronary syndrome with fulminant liver failure with heart failure with organ transplantation when arterial blood gases not be available patient refusal patient with HCC