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Cohort studies show that median survival in cirrhotic patients that present with overt HE is only a few months and they have a 2-times higher risk for death at one year of follow-up, compared with cirrhotic patients without HE.6,7 In Mexican patients with cirrhosis, the prevalence of MHE has been reported at 11.5%.8 According to an October 2018 press release, HE accounts for 10% of all hospital admissions at a tertiary care referral center in Mexico City.9 Definitions and classification 1 HE is defined as a brain dysfunction caused by liver failure and/or portosystemic blood shunting