Unspecified hospital in Adelaide

62-year-old female, day 5 ICU, admitted with decreased level of consciousness from hepatic encephalopathy, secondary to decompensated liver disease with acute renal failure and haematemesis. Findings on examination included signs of decompensated chronic liver disease and hepatic encephalopathy, intubated on minimal ventilatory support and haemodynamic stability.

Candidates were directed to provide a differential diagnosis for her decreased level of consciousness and to provide a management plan.

Discussion points included interpretation of investigations, precipitants of hepatic encephalopathy and prognostication.