All right, welcome back to the Internet Book of Critical Care podcast. I'm here with Adam Thomas,

and we're going to discuss critical hepatic encephalopathy. Just in case you weren't clear about this,

we're going to give you a 20-minute podcast on how to get this straight, really important. We'll cover all

the big things. You got your double laxative coverage. You got your utility ammonia and you got your tips and then

everything in between. So Josh, let's start it off intro. What is severe hepatic encephalopathy?

How is that different in the context of chronic versus acute fulminate liver failure?

Yeah, so this chapter is about severe hepatic encephalopathy.

So we're talking about folks who are in the ICU with somnolence and, you know, more so

folks who are intubated due to hepatic and subopathy.

So this is like the most severe extent of it.

And the other piece here is that we're talking about folks of acute hepatic failure with encephalopathy in a different

chapter. And that's like an entirely different beast, which is far more malignant and much scarier.

What kind of prognosis do these patients have? Is it different than the acute forminant

failure? When we get here, can I turn them around? Are they okay for this admission? What's up?

The acute ones, you know, typically they're like on the

break of death and most often they may die if they don't get a transplant. We'll talk about that

later. As far as the chronic patients, the overall prognosis is poor without a liver

transplants. And unfortunately, logistics being what they are, most patients are not going to be

transplant candidates. So the overall prognosis of these patients is poor. That being said,

I think that most of these patients who are intubated with hepatocenceophopathy, we can actually get them

through their ICU course and get them extubated. There's this weird duality of the overall

prognosis is poor, but we can generally kind of salvage them temporarily. We can win the temporary

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