This is acute liver failure (acute HBV, INR/PT prolonged, encephalopathy) in a previously normal liver. The course lecture warns that treatments used for chronic liver disease may be inappropriate in ALF and that lactulose is potentially dangerous (gas/bloating that interferes with transplant); management is supportive: correct hypoglycaemia (IV glucose/dextrose) and PPI to prevent GI bleeding, with early transplant referral. However, OnlineMedEd and Step-Up notes in the same channel list lactulose for ALF encephalopathy, which is why the old bank keyed C (lactulose + IV glucose). A low-protein diet is not recommended.