I don't know if he has asterixis (I'm going to have to study up on that one) but he has lost a massive amount of muscle from all of this and definitely has HE. I didn't think it possible to atrophy so quickly. He has trouble with coordination and standing completely upright. His billirubin is definitely high (bright orange to blood red). What is odd is that when he's been symptomatic before it's largely been a matter of increasing his lactulose and making sure he was having enough BMs but this time it's as though he's not responding at all to the lactulose beyond having BMs. Normally, when it's HE his symptoms go away with an increased dose.
That said, he has had mirror symptoms of HE when he's had sodium/potassium imbalances and a few years prior when he had an acute episode of kidney failure. I'd have to check my notes but I think his last brain scan was only about 2 months ago and there was nothing there.