Hello Lost and welcome,
Ive been thru more HE episodes with my brother than I care to count. In frustration, I asked his doc how can I prevent this from happening all the time?
He said "Lactulose, Lactulose, Lactulose!"
When my brother started with the shakes and get confused, the ONLY thing that helped was the lactulose. Sometimes you need to start with once every hour like they did in the hospital (when he was almost unresponsive) or sometimes they give a lactulose enema first (like in the ER) and then tons of lactulose until he starts to come out of it. Im not sure if hubby gets it as bad as my brother, but that is all that worked. BTW, he was also taking xifaxin.
The trouble is, by the time the patient has HE, he/she is too confused/stubborn already to realize the importance of taking the medicine!
Also, on a weekend inpatient episode over at Mayo, the doc (not on tx team) restricted his fluids while prescribing high doses of lactulose (big mistake, damaged his kidney). I guess he was worried about the ascites, thankfully he didnt need dialysis.
If you cant affort the meds, someone here can steer you in the right direction for need-based prescription assistance Im sure :)
Good luck, hepatic encephalopathy really s**ks and can be very dangerous!