Snapshot A 50-year-old man with cirrhosis is brought to the emergency room for altered mental status. He lives at home with his mother, who noted that he was slow in his responses and disoriented. He has a history of alcoholic cirrhosis, and for the past week he has not eaten much food. His last drink was a day ago. On physical exam, he is noted to be jaundiced with asterixis. His mucous membranes are dry and his capillary refill is delayed. An ultrasound of his abdomen shows ascites. Labs are significant for hyperkalemia and elevated ammonia to 200 μmol/L. He is started on lactulose and rifaximin and admitted to the inpatient unit for further management. Introduction Pathogenesis login to view 7 more bullets Associated conditions login to view 3 more bullets Overview login to view 2 more bullets Epidemiology Incidence login to view 1 more bullet Risk factors login to view 2 more bullets Etiology Acute triggers login to view 7 more bullets Classification Classification by underlying disease login to view 6 more bullets Presentation Symptoms login to view 4 more bullets Physical exam login to view 10 more bullets Imaging CT or MRI of the head login to view 4 more bullets Studies Serum labs login to view 5 more bullets Differential Other metabolic encephalopathies login to view 9 more bullets Treatment Nonoperative login to view 11 more bullets Complications Persistent learning impairment Prognosis Hepatic encephalopathy is reversible