Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. We will try to help you in best way possible. First of all it s sad to know what your friend had been going through lately. Based on the history you have shared, I am afraid that he prognosis is not very good however supportive measures like good hydration and nutrition is a must for better outcomes. If oral feeding isn t tolerable injectable fluids and supplements should be started. Constipation should be avoided with use of lactulose and that will help to decrease the ammonia levels and drowsiness and lethargy will also decrease. Avoid too much protein intake and high fat diets. Supplements for vitamins and essential minerals should also be commenced. Hope I have answered your query. Let me know if I can assist you further.