Question

A 58-year-old man with decompensated alcoholic cirrhosis becomes confused and drowsy. He has a flapping tremor. Ammonia is elevated. What is the most appropriate first-line pharmacological treatment?

Accepted Answer

Lactulose to achieve 2–3 soft stools per day

Answer

High-dose intravenous steroids

Answer

Propranolol

Answer

Long-term Rifaximin alone without Lactulose

Answer

No treatment; this is irreversible dementia

Practice question

A 58-year-old man with decompensated alcoholic cirrhosis becomes confused and drowsy. He has a flapping tremor. Ammonia is elevated. What is the most appropriate first-line pharmacological treatment?