Volume 1 - Issue 4, November - December 2025

This case report describes the acute decompensation of a 42-year-old male with end-stage nonalcoholic steatohepatitis (NASH)–related cirrhosis complicated by chronic hypothyroidism and hypoadrenalism. The patient presented with progressive jaundice, profound fatigue, and life-threatening electrolyte disturbances, including severe hyponatremia and hypokalemia, with a documented history of hyponatremia-related seizures. Management required strict fluid restriction, albumin infusion, electrolyte correction, infection prophylaxis, and neurological protection. Critical review of inpatient and discharge management revealed systemic gaps, including delayed diuretic initiation and lack of clarity regarding lactulose titration. Clinical pharmacist intervention was pivotal in preventing high-risk drug–drug interactions, particularly between levothyroxine and calcium supplementation, and in optimizing hepatic encephalopathy prophylaxis. The patient was discharged with a MELD score of 24 and remains active on the deceased donor liver transplantation waitlist. This case highlights the indispensable role of clinical pharmacy services in complex hepatology care.