How do you manage a patient's chronic methadone when they are admitted to the hospital for acute toxic-metabolic encephalopathy due to another cause (e.g., alcohol intoxication/withdrawal, hepatic encephalopathy, etc.)?

Continue it unless I have a compelling reason to stop. These reasons may include lethargy/inability to arouse and low respiratory rate. In that case, I may halve the dose initially to try to wake the patient up, then hold altogether if need be.