Lactulose is a synthetic sugar used to treat constipation. It is broken down in the colon into products that pull water out from the body and into the colon. This water softens stools. Lactulose is also used to reduce the amount of ammonia in the blood of patients with liver disease.
• Lactulose (disaccharide)
- Osmotic laxative, water remains in lumen, faster transit time, less time for ammonia to enter body
- Preferentially metabolised by gut bacteria compared to glutamine, less ammonia produced
- Decreases pH by increasing acid production by gut bacteria (lactic and acetic acid) so ammonia converted into ammonium which isn’t absorbed
- For liver failure
- 30-45ml 2-4x daily oral. Available in enema for unconscious
- Titrate against symptoms with goal of 2-3 soft stools per day
- Decrease ammonia in 3 ways
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- Increases colonic transit and decreases uptake
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- Increases ammonia uptake by colonic bacteria due to the reduced pH
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- Reduces intestinal production of ammonia as it is preferably metabolised by bacteria compared to glutamine and therefore less amonia production
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