What treatment is anticipated for confusion in a patient with liver failure?

In patients with liver failure, confusion is often a manifestation of hepatic encephalopathy, which can be worsened by the accumulation of toxins, particularly ammonia, in the bloodstream due to impaired liver function. Lactulose is the treatment of choice in this scenario because it works by reducing the absorption of ammonia in the intestines and promoting its elimination through the feces. It acts as an osmotic laxative, drawing water into the bowel, thereby softening stools and increasing the frequency of bowel movements. This process not only helps reduce ammonia levels but also alters the gut flora to produce less ammonia.

The use of other treatments listed, while important in different contexts, do not directly address the underlying issue of elevated ammonia in hepatic encephalopathy. Activated charcoal is primarily used for toxin ingestion and would not be effective in the case of ammonia accumulation. Insulin therapy relates more to glucose management rather than addressing hepatic encephalopathy. Thiamine supplementation is crucial in preventing Wernicke's encephalopathy in alcohol-related disorders but is not a direct treatment for the confusion associated with liver failure.

Therefore, starting lactulose is the most appropriate and effective approach for managing confusion due to hepatic encephalopathy in a patient with liver failure.