To think Lactulose was approved back in 1977 by the FDA – this one has been around and proven itself for a long time ! On one hand while it can clear the fog in hepatic encephalopathy, the same drug is also paradoxically implicated in precipitating hepatic encephalopathy !
How can in trigger hepatic encephalopathy ?
- It can induce dehydration from overzealous use
- Excess stooling results in hypokalemia and hypokalemia increases ammonia !
- Cramping, bloating, pain and nausea from Lactulose excess results in non-compliance
(have covered all of the above in triggers of hepatic encephalopathy)
💡 Some tips to avoid this:
- Use higher doses of Lactulose only initially in acute encephalopathy, goal of up to 5 soft stools a day
- Once mentation is clear, cut back doses to aim for just up to 2-3 soft stools a day
- If abdominal symptoms persist despite reduced doses, consider adding another laxative agent to allow further reduction in Lactulose dose while maintaining a target of 2-3 soft stools a day
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