Case Presentation: A 16 year old boy with obesity presented for dehydration in the setting of three months of abdominal pain, nausea, and non-bloody, non-bilious emesis. Outpatient work-up had been unrevealing. He also endorsed cannabis use and vaping. He had lost 70 pounds during this time. New symptoms in the days prior to admission included dizziness [...]

Case Presentation: A 38-year-old Caucasian male with no significant prior medical history presented with an acute CVA based on the presence of fatigue, blurry vision, ataxia, headache, and numbness. His MRI showed “multiple small foci of high DWI/ADC signal” in the bilateral cerebral and cerebellar hemispheres consistent with small acute infarcts. Unremarkable CTA brain/neck, ECHO, [...]

Background: Systemic muscle relaxant prescriptions have risen in United States. Baclofen is a commonly prescribed muscle relaxant that is gamma-aminobutyric acid (GABA) agonist and renally cleared. We aimed to determine the risk of encephalopathy and mortality associated with baclofen compared to an alternate muscle relaxant cyclobenzaprine in a real-world setting. Methods: We conducted a retrospective [...]

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 [...]

Case Presentation: A 40-year-old woman with a history of anxiety presented with one week of diffuse abdominal pain, associated with constipation, decreased oral intake, nausea, and bilious emesis three times a day. She was admitted to an outside hospital one month prior with similar symptoms and treated for pneumonia. The patient lives alone and denied [...]

Case Presentation: The patient is an immunosuppressed 57 year old male with small bowel and liver transplant due to trauma from a motor vehicle accident 20 years prior and end ileostomy due to anal carcinoma. His chief complaint was “dizziness,” consisting of lightheadedness and diplopia. His wife described three months of progressive forgetfulness and fabricating [...]

Background: Rifaximin, a nonsystemic antibiotic, may be used alone or in combination with lactulose for reducing the risk of overt hepatic encephalopathy (OHE) recurrence in adults. This analysis evaluated rifaximin alone and rifaximin + lactulose (combination) on health-related quality of life (QOL) and caregiver burden in patients with a history of OHE. 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: Hepatic encephalopathy (HE) is a common neurological complication in patients with cirrhosis. In addition to numerous morbidity-related issues, HE is associated with substantial economic burden. Treatment includes lactulose or rifaximin, a nonsystemic antibiotic that is indicated for reducing the risk of overt HE recurrence in adults. Rifaximin has also been shown to reduce the [...]

Case Presentation: We present a case of a 20-year old male with past medical history of polysubstance abuse and major depressive disorder who was found unresponsive by his roommate in the morning after black tar heroin use. Roommate injected Narcan without effect and called EMS. Roommate reported both the patient and himself were chronic heroin [...]