# Altered mental status - Most likely due to hepatic encephalopathy given cirrhosis and lactulose non- adherence. Possible opioid use given unclear history and pinpoint pupils. Less likely stroke given normal CT, electrolyte derangements given normal CMP, etc. - Continue lactulose, refer to hepatology on discharge
# Altered mental status, improved # Hepatic encephalopathy, improving - Most likely due to lactulose non-adherence. - CT head negative - UDS negative Plan: - Lactulose 20 g TID for 500 cc of stools - Hepatology referral on discharge - Cirrhosis management as elsewhere
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