Avoid benzodiazepines unless prescribed by liver specialist
Avoid new sedating medicines
Check with pharmacist or clinician first
Hydration plan
Drink fluids unless fluid restriction prescribed
Monitor for dizziness or low urine output
Return to ED now for
Worsening confusion
Unable to stay awake
Fever
Shaking chills
Vomiting blood
Black tarry stools
New severe headache
Weakness or numbness on one side
Shortness of breath
Chest pain
Follow up
Liver clinic or family doctor within 7 days
Earlier if symptoms recur
Caregiver plan
Do not drive until cleared
Reliable adult supervision for 24 to 48 hours
Clinical guidelines and evidence
Guideline and key evidence sources
AASLD EASL Practice Guideline on hepatic encephalopathy in chronic liver disease
Lactulose first line for overt HE
Rifaximin add on for recurrent HE
EASL clinical practice guidance on decompensated cirrhosis
Precipitant evaluation emphasis
Avoid unnecessary protein restriction
Major randomized trials of rifaximin for HE recurrence prevention
Reduced breakthrough HE episodes
Reduced HE related hospitalization
Society guidance on SBP evaluation in cirrhosis with altered mental status
Diagnostic paracentesis when ascites present
Early empiric antibiotics when unstable
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.