Background: Rifaximin 550 mg tablets is a nonsystemic antibiotic indicated for reducing the risk of overt hepatic encephalopathy (OHE) recurrence in adults and may be used alone or in combination with the cathartic lactulose. This analysis evaluated the safety profile of rifaximin alone vs rifaximin + lactulose (combination) in patients with cirrhosis. Methods: In a [...]

Background: Hepatic encephalopathy (HE) is a common complication in patients with end stage liver disease. Variability in presentation can be a source of clinical uncertainty for medical providers. Ammonia levels have historically been used to aid in the diagnosis of HE despite low positive and negative predictive values. Our primary objective was to determine the [...]

Background: Rifaximin 550 mg tablets is a nonsystemic antibiotic indicated for reducing the risk of overt hepatic encephalopathy (HE) recurrence in adults and may be used in combination with lactulose. Practice guidelines state that rifaximin is effective as add-on therapy to lactulose for preventing overt HE recurrence. This pooled analysis evaluated the efficacy and safety [...]

Case Presentation: A 43-year-old male with roux-en-y gastric bypass fourteen years ago with complications and multiple adhesions, hiatal hernia associated with nausea and vomiting, and subsequent small bowel resection last year, started to experience cognitive changes and short-term memory loss. He has also experienced problems with balance, generalized weakness, and unintentional 60-pound weight loss. His [...]

Case Presentation: An 86-year-old woman with history of EBV encephalitis four years prior presented for altered mental status and emesis in September. Previously, the patient was able to perform all activities of daily living. A week prior to presentation, patient developed a cough and was noted to have slow mentation. Exam was notable for fever [...]

Case Presentation: A 33-year-old male without significant medical history experienced visual changes, left-sided tingling and weakness, vertigo, nausea, and mild expressive aphasia for 2 months. At that time, he had mild upper extremity tremor and was able to walk, drive, and perform activities of daily living. On physical exam, the patient demonstrated left upper extremity [...]

Case Presentation: A 64 year old man with a history of membranous nephropathy on tacrolimus and recent cerebral arteriovenous malformation (AVM) repair, with stent placement seven months prior, presented to the emergency room with one day of progressive lethargy, frontal headache, photophobia, and confusion with subjective fevers and nausea.His vitals on presentation were significant for [...]

Case Presentation: A 59 year-old woman with uncontrolled diabetes mellitus and end-stage kidney disease on hemodialysis presented with altered mental status and a suprapatellar abscess. Following irrigation and debridement, her course was complicated by septic shock. She was found with high-grade methicillin-sensitive Staphylococcus aureus bacteremia, and her blood cultures ultimately sterilized with IV cefazolin therapy. [...]

Case Presentation: A 69 year old male was brought to the emergency department from a rehabilitation facility with altered mental status. Two months ago, he had been admitted for lumbar osteomyelitis for which he was started on Vancomycin and Cefepime and was discharged to a rehabilitation facility. After six weeks of therapy, he was more [...]

Case Presentation: A 43-year-old Caucasian woman with stage IV rectal adenocarcinoma metastatic to liver and lung presented with new onset generalized tonic clonic seizures. She was receiving her second line treatment with 5-FU continuous infusion Day number 7 of 7 of the 5th cycle. This was preceded by confusion and altered mentation since the previous [...]