{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:16:19Z","timestamp":1787019379257,"version":"build-2736575974"},"reference-count":15,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medical Case Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Refractory status epilepticus complicating hepatic encephalopathy poses unique palliative challenges as standard extubation protocols typically reduce or discontinue sedative infusions, risking immediate seizure recurrence and distress. We report a 53-year-old man with end-stage cirrhosis and hepatocellular carcinoma who developed hepatic encephalopathy and refractory status epilepticus precipitated by small bowel obstruction. Despite ammonia-lowering therapy and multiple antiseizure medications, seizures remained refractory. Electroencephalography confirmed status epilepticus despite escalating therapy. Given prohibitive surgical risk and poor prognosis, the multidisciplinary team and patient\u2019s family elected to withdraw life-sustaining treatments, requesting he not die with an endotracheal tube in place. He underwent palliative extubation while continuing propofol and midazolam infusions to suppress seizure activity and ensure comfort. He died peacefully without visible seizure activity. Although limited by a single patient, this case provides a practical example of a rarely described palliative strategy: continuing sedative infusions during palliative extubation to prevent agonal seizures in refractory status epilepticus.<\/jats:p>","DOI":"10.1177\/2050313x261468910","type":"journal-article","created":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T11:11:46Z","timestamp":1784373106000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Continuation of sedative infusions during palliative extubation for refractory status epilepticus in hepatic encephalopathy: A case report"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3132-8431","authenticated-orcid":false,"given":"Liam D.","family":"Ferreira","sequence":"first","affiliation":[{"name":"Department of Neurology, The University of Texas at Austin Dell Seton Medical Center, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shailaja","family":"Hayden","sequence":"additional","affiliation":[{"name":"Department of Pulmonology and Critical Care, The University of Texas at Austin Dell Seton Medical Center, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11011-024-01402-y"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.07.013"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2014.06.004"},{"key":"e_1_3_3_5_2","article-title":"Hepatic encephalopathy induced by small bowel obstruction in a patient with primary biliary cholangitis","volume":"17","author":"Elbasheer A","year":"2025","unstructured":"Elbasheer A, Ahmed SMM. Hepatic encephalopathy induced by small bowel obstruction in a patient with primary biliary cholangitis. Cureus 2025; 17: Article e87169.","journal-title":"Cureus"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2023.03.011"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318228235d"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-025-02228-x"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-020-00747-z"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12182"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3390\/ph17040473"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.14581\/jer.21023"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcadva.2025.100146"},{"key":"e_1_3_3_14_2","article-title":"Propofol-related infusion syndrome: a clinical review","volume":"14","author":"Singh A","year":"2022","unstructured":"Singh A, Anjankar AP. Propofol-related infusion syndrome: a clinical review. Cureus 2022; 14: Article e30383.","journal-title":"Cureus"},{"key":"e_1_3_3_15_2","article-title":"Propofol-related biological alterations and incidence of propofol infusion syndrome in status epilepticus: a 10-year cohort study","volume":"16","author":"Djahel C","year":"2025","unstructured":"Djahel C, Marois C, Cosme L, et al. Propofol-related biological alterations and incidence of propofol infusion syndrome in status epilepticus: a 10-year cohort study. Front Neurol 2025; 16: Article 1753979.","journal-title":"Front Neurol"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2026.01.025"}],"container-title":["Sage Open Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X261468910","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2050313X261468910","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X261468910","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:16:33Z","timestamp":1784535393000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2050313X261468910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":15,"alternative-id":["10.1177\/2050313X261468910"],"URL":"https:\/\/doi.org\/10.1177\/2050313x261468910","relation":{},"ISSN":["2050-313X","2050-313X"],"issn-type":[{"value":"2050-313X","type":"print"},{"value":"2050-313X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"2050313X261468910"}}