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Lactulose

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Lactulose

  • See Also
  1. Laxative
  2. Osmotic Laxative
  3. Constipation
  4. Functional Constipation
  5. Pediatric Constipation
  • Mechanism
  1. Converts Ammonia to unabsorbed Ammonium
  2. Produces Diarrhea
  3. Alters bowel flora
  • Indications
  1. Hepatic Encephalopathy (in Cirrhosis)
  2. Constipation
  • Advantages
  1. Poorly absorbed (may be used in Renal Failure)
  1. Not as effective or well tolerated as Miralax
  • Dosages
  1. Constipation
    1. Lactulose (Chronulac)
      1. Consider Sorbitol 70% as alternative agent
      2. Adults: 30 ml PO qhs
      3. Children (10 mg/15 ml) 1-3 cc/kg/day divided qd-bid
        1. Easier to administer to young children
      4. May cause abdominal cramping and Flatus
    2. Lactitol
      1. As effective as Lactulose with less pain and Flatus
      2. Pitzalis (1995) Pediatr Med Chir 17(3):223-6 [PubMed]
  2. Hepatic Encephalopathy
    1. Initial: 30-50 ml PO qh until Diarrhea
    2. Next: 15-30 ml PO tid-qid prn 2-3 stools/day
  3. Hepatic Coma
    1. Lactulose 300 ml in 700 ml water retention enema