Discuss lactulose?

Lactulose is a first-line pharmacological treatment of hepatic encephalopathy. It is also used as a laxative.

• Lactulose (galactosido-fructose) is not broken down by intestinal disaccharidases and thus reaches the colon, where bacteria will metabolize the lactulose to acetic acid and lactic acid. This lowers the colonic pH and thus favours the formation of the nonabsorbable NH4+ from NH3, trapping NH3 in the colon and effectively reducing plasma ammonia concentrations. Other effects like catharsis also contribute to the clinical effectiveness of lactulose.
• An excessively sweet taste, flatulence, and abdominal cramping are the most frequent subjective complaints with this drug.
• For acute encephalopathy, lactulose (ingested or via nasogastric tube), 45 ml p.o., is followed by dosing every hour until evacuation occurs. Then dosing is adjusted to an objective of two to three soft bowel movements per day (generally 15–45 ml every 8–12 h).
• Lactitol is more palatable and can be used instead of lactulose. Both are equally efficacious.