Case Presentation: A 46 year-old man with decompensated cirrhosis (MELD 45) presented with dizziness and confusion for two days. He denied any other new symptoms. Home medications included lactulose, propranolol, pantoprazole, folic acid and thiamine. On arrival, the patient was normothermic (99.2 F), with bradycardia to 30-40 BPM and blood pressures of 80s/40s mmHg. He [...]