A Case of Misdiagnosis of Hepatic Encephalopathy

Misdiagnosing hepatic encephalopathy is a common occurrence in the emergency department. Hepatic encephalopathy may present with symptoms very similar to other comparable diseases; therefore a correct diagnosis is of pivotal importance. The most common clinical features that present in patients with hepatic encephalopathy can be very nonspecific such as fatigue, apathy, irritability, disorientation, lethargy, and confusion. In contrast, more specific symptoms such as slurred speech, asterixis, muscle rigidity, and psychiatric disturbances present less commonly; thus making a correct diagnosis of hepatic encephalopathy remains challenging. Hepatic encephalopathy results in neurological deterioration that manifests as worsening cognitive and neurologic function. Although several other diseases present with similar manifestations, an accurate clinical assessment with precisely ordered investigations stands as the best way to prevent a misdiagnosis. Here we discuss a case of misdiagnosed hepatic encephalopathy and outline the best evidence-based approach to avoid a misdiagnosis and deliver the most appropriate next best step in management.