Is there a serum ammonium level for which you recommend initiation of dialysis in a patient with hepatic encephalopathy?

Because there is a very poor correlation between ammonia levels and hepatic encephalopathy, I do not make recommendations based on ammonia levels. My approach is to treat each case individually in consultation with our hepatology colleagues. If a patient has encephalopathy and is not responding to m...

This will be a helpful article: Paine & Pichler, PMID 37847521.

Whether there is a path forward for the patient is the most important question to answer for me. Resources should be used when justified!