DDSEP® 8 Quick Quiz

September 2020 - Quick Quiz Question 2

Publish date: October 23, 2020

Q2. A 62-year-old man with hepatitis C cirrhosis is admitted with altered mental status. He had a recent dental procedure and was given pain medication and a short course of antibiotics. He is taking only spironolactone 50 mg for small ascites. The patient is alert but not oriented to place and time. He has evidence of asterixis. His mucous membranes are dry and he has no evidence of ascites on exam. His labs include WBC 4.7 x 103/mm3, AST 45 U/L, ALT 40 U/L, total bilirubin of 2.5 mg/dL, albumin of 3.7 g/dL, sodium 142 mEq/L, and a creatinine of 0.5 mg/dL.

What is the LEAST likely etiology of his encephalopathy?

Infection

Constipation

Narcotic use

Volume overload

Gastrointestinal bleeding

Q2: Correct answer: D

Rationale
Episodic hepatic encephalopathy is usually precipitant induced in over 80% of cases and precipitants include dehydration, infections, over diuresis, gastrointestinal bleeding, constipation, and the use of narcotics and sedatives. The key is to identify and treat the precipitant. A diagnostic workup to rule out other disorders that can alter brain function and mimic hepatic encephalopathy should also be performed.

Reference
Viltstrup H et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715-35.

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September 2020 - Quick Quiz Question 1