A patient with acute liver failure shows incoherent speech and cannot follow instructions. What grade of hepatic encephalopathy does he demonstrate?

The symptoms described indicate that the patient is exhibiting significant cognitive impairment associated with hepatic encephalopathy. In this context, incoherent speech and the inability to follow instructions suggest marked confusion and altered mental status, which aligns with Grade III hepatic encephalopathy.

Hepatic encephalopathy is typically graded on a scale from I to IV, with advancing grades indicating worsening neurological function. Grade I is characterized by mild changes in behavior and cognitive function, often unnoticed by the patient. Grade II involves more pronounced confusion and lethargy, but patients can still follow simple commands. Grade IV, on the other hand, represents coma and unresponsiveness.

Since the patient demonstrates incoherent speech and cannot follow instructions, this points towards a more severe stage of hepatic encephalopathy, specifically Grade III, where there is evident confusion, but the patient may still be arousable. Understanding these gradations is essential for healthcare professionals to evaluate the severity of liver dysfunction and to guide appropriate management strategies.