A 70-year-old man with a history of cirrhosis, ascites, and hepatic encephalopathy was admitted for abdominal pain and shortness of breath. He had been recently hospitalized for the same symptoms. This admission was for a liver transplant evaluation. Several days after admission, he developed acute hepatic encephalopathy, secondary to Streptococcus mitis bacteremia. Advance care planning had not yet occurred.
Over the next several days, his encephalopathy gradually improved with antibiotics and lactulose treatment, and the possibility of liver transplant was again discussed with the patient and his wife. At that time, the couple raised questions regarding the risks and benefits of such an invasive procedure. Understanding he was at high risk for mortality, surgical complications, and poor quality of life, the patient and his wife struggled to process through the next steps.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Raymond Y. Yeow, MD, Division of Cardiovascular Medicine, Michigan Medicine, 1500 East Medical Center Dr, Ann Arbor, MI 48109 (firstname.lastname@example.org).
Published Online: November 23, 2020. doi:10.1001/jamainternmed.2020.6564
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient’s spouse for granting permission to publish this information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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