@rowdyramsey I almost lost my life during the first HE episode. The first 48 hours were just touch and go as to whether I would survive it. I was hospitalized in intensive care for a week then they moved me to a private room for extensive care. I think that would qualify as pretty severe. The next 6 months are a blur, no memory of that time or awareness to my surroundings. Subsequent episodes landed me in hospital a week at a time. I took lactulose (30 ml) every four hours and then I also took rifaximin. I didn't suffer from a lot of diahrea but made sure I drank lots of water to keep hydrated. I now feel a bit foggy at times but my memory is pretty good and I tend to make lists and enter everything into my calendar.