@contentandwell my HE episode occurred shortly after diagnosis I don’t remember the dosage but took it 4 times a day. A month and a half later I was being evaluated at Mayo they added xifaxin and had me titrate the lactulose but I still had issues. I met 2 patients at Mayo that had MELDs in the mid 40’s before it happened to me. I read an article about increasing the MELD scale because more people are having scores above 40. I do not remember where I read this, sorry. Having only one HE episode but noticed short term memory problems before transplant too. My local Gastroenterologist asked me in September if I suffered brain damage. I responded “no” but since then am starting to believe my short term memory issues may be brain damage.