Lactulose (want to achieve 2-3 soft bowel movements per day)
- Lactulose prevents ammonia (NH3) from diffusing out of the colon and into the blood. Thus reducing the amount of ammonia in blood
- HOW? Intestinal flora metabolizes lactulose producing organic acids and lowering pH => converting NH3 to NH4 (ammonium)
*It also acts as a laxative to eliminate nitrogen-producing bacteria
1. Weber FL Jr. Lactulose and combination therapy of hepatic encephalopathy: the role of the intestinal microflora. Dig Dis. 1996;14 Suppl 1:53-63.