Assessing and treating hepatic encephalopathy in the older patient

Altered mental status (AMS) and confusion are common reasons older patients may be admitted to a hospital. Hepatic encephalopathy (HE) is associated with confusion and AMS. The following case describes an older male presenting with confusion. The patient is treated for both a urinary tract infection and HE. The differential diagnosis for AMS is important for pharmacists to understand and evaluate to ensure appropriate treatment as well as rule out other medication-related causes of AMS. Managing patient compliance for the pharmacotherapy necessary to treat and prevent HE is particularly important to avoid future hospital admissions and complicated placements to an extended-care facility.