Delirium Tremens with Hepatic Encephalopathy, a Diagnostic Dilemma: A Case Series

Hepatic encephalopathy is brain dysfunction caused by liver damage that can occur due to an array of etiological factors. Delirium tremens, on the other hand, is a severe and life-threatening form of alcohol withdrawal. These two conditions can closely resemble each other in their presentations, with disorientation being a hallmark in both scenarios, which makes diagnosis and treatment difficult in some cases. Quick and precise diagnosis and rapid intervention during the hospital course are essential in these critical conditions for deciding the course of action and the treatment modalities. We report a case series of patients who presented with a diagnostic dilemma, having signs and symptoms of both conditions simultaneously. All four patients had a prolonged history of alcohol consumption, with recent cessation of drinking before symptom onset. Each patient exhibited disorientation, restlessness, or drowsiness, along with elevated serum ammonia levels, consistent with hepatic dysfunction. All four cases were successfully treated with lorazepam, thiamine supplementation, lactulose therapy, and supportive measures.