Sedative-Precipitated HE — RACP Adult Medicine MCQ

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EasyGastroenterologySedative-Precipitated HERACP Adult Medicine

A 55-year-old woman with cirrhosis presents with worsening HE. She was well until 3 days ago when she was prescribed temazepam for insomnia by her GP. She is drowsy with asterixis. What is the most likely precipitant?

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Correct answer: E — Sedative medications

Benzodiazepines (temazepam) and other sedatives (opioids, antihistamines) are common precipitants of HE in cirrhotic patients. The cirrhotic liver has reduced drug metabolism, and the blood-brain barrier is more permeable to sedatives. All sedatives should be avoided or used with extreme caution in cirrhosis. Flumazenil may transiently improve benzodiazepine-precipitated HE.

Reference: GESA – 2024 – HE; AMH 2025 – Hepatic Impairment