Correct Answer: B — West Haven Criteria, Grade III–IV

West Haven Criteria for Hepatic Encephalopathy:

Grade	Features	Management
0	No symptoms; subtle cognitive deficits only on testing	Outpatient
I	Mild confusion, euphoria/anxiety, shortened attention span	Outpatient / ward
II	Lethargy, disorientation, asterixis (flapping tremor), personality change	Ward / HDU
III	Somnolence but arousable, gross disorientation, bizarre behaviour, asterixis	ICU admission
IV	Coma — unresponsive to stimuli	ICU — intubation likely

Treatment: Lactulose (first-line), rifaximin, treat precipitating causes (infection, GI bleed, electrolyte imbalance), nutritional support (avoid protein restriction), liver transplant evaluation.