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Quality of evidence: II-B, Strength of recommendation: 1 Panel level of agreement: In total agreement 87%, in partial agreement 13% Patients with ALF, HE, and at risk for an increase in ICP should be managed in a calm environment, with serum sodium monitoring (maintaining levels between 140 and 145 mmol/l) and HE treatment with lactulose and rifaximin

The result is a reduction in appetite and caloric intake that, combined with lifestyle adjustments, leads to meaningful weight loss over time

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If uncertainty remains about what metformin does for pcos, a consultation with a healthcare professional can help determine whether treatment is suitable, safe and aligned with personal health goals