This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
Which of the following is not a component of Reynolds' Pentad in toxic cholangitis ? 
Select and explain. 
A. Right upper quadrant pain, B. Confusion, C. Septic shock, D. Markedly elevated transaminases
D: Markedly elevated transaminases
Answer: D: Markedly elevated transaminases 
Explanation: None