Lactulose isn’t used just to treat constipation. For patients with LIVER PROBLEMS, it draws out the ammonia for them and into the colon so they can poop it out.. Whereas if they had no liver problems, their liver would be able to get rid of the ammonia. Normal ammonia levels are 11-35 mg/dL at Kaiser. So when giving lactulose, see what they’re actually getting it for. Why did the doctor order it? Does the patient have high ammonia? A big hint is if they’ve got a bad liver.
Today I had a 71 year old female patient who came in for sepsis. Past medical history included non-alcoholic cirrhosis of the liver, diabetes mellitus 2, and osteoarthritis. Her meds included lactulose 10g/15mL and phytonadione/Mephyton (VITAMIN K) 10mg.
I couldn’t figure out why she had lactulose or vitamin K. I haven’t learned anything about liver failure in med-surg yet, so I asked the nurse about it and she had explained to me the pathophysiology of it. It all made sense afterwards. (For future reference, look up the patho of your pt’s disease processes, whether you’ve already learned them or not.)
The reason she was getting lactulose is not only because she’s constipated, but also to keep her ammonia levels down. (Though she refused it at the time I was there to pass her meds because she was having a lot of loose stools).
The liver is also responsible for making the body’s clotting factors, including prothrombin. Her hepatic function is compromised due to cirrhosis, so she’s not making those clotting factors, thus her PT is prolonged. (I looked up her morning labs for INR and she was 1.2, so she was fine) This is why she’s getting VITAMIN K, which is a clotting factor.
