We just admitted a women in the end stage of cirrhosis of the liver, non alcoholic, and she came with orders for lactulose QID! Already has loose stools daily x 2-3 but we were told there is a reason for this. Can anyone tell me what the reason is? Inquiring minds want to know why we want to cause diarrhea in a liver failure patient?

The lactulose pulls ammonia from the bloodstream in to the colon, which is then excreted in the stool.

According to the MD the pt is in the end stage, will not be getting a transplant and is basically here to be taken care of until the end. The husband really wants to take her home. She already has encephalopothy and can be sweet as sugar one minute and cursing you out the next. Feel really bad because she hates taking it and her husband begs her to everytime.

Anonymous says ...

In a liver failure patient, ammonia levels can rise quickly. Lactulose helps keep those levels from getting to the point of hepatic encephalopathy in which the patient basically goes in to dementia before your eyes. Maybe they are trying to buy the patient some time if they are on a transplant list or are going for surgery?

This sounds right, I worked in a liver unit before, and patients with allevated  ammonia levels, will be very aggitated, and confused. The nurses on the unit will some times have to put the patient on 4 point leather restraints, and use haldo, and ativan to controll the patient, from being combative to all the other nurses and techs. Cuttie

I put this in the anonymous zone because it is dealing with an actual patient I have right now. I just don't want anything to come back on me about HIPPA. She is not on hospice because the famiuly does not think they can afford it. She is not old enough for medicare and does not qualify for medicaid. Crappy situation really. According to the MD she really wont be getting better, she hates taking the lactulose and is very uncomfortable with all the loose stools.  The husband wants her to take it and she want s to do what he wants because she loves him and wants him to be happy.

I don't know does this have something to do with any of the posts above?  I think its about a liver pt.

Anonymous says ...

Why would a person with double pneumonia get lactulose? 

Does lactulose help in a pneumonia patient too?

Thanks guys for clearing up  my question, I don't even have a slight recolection of learning about that in school. Get some good info from expereince though! Thanks again

To really clear it up. Here goes. My friend had no s+s of a cold. No s.o.b. He does have Hep C.  He was getting a little confused.Temp was 102.4. after he finally saw a Dr. He was admitted. His said his ammonia level was high. He was not constipated he stated.

Anonymous says ...

I put this in the anonymous zone because it is dealing with an actual patient I have right now. I just don't want anything to come back on me about HIPPA. She is not on hospice because the famiuly does not think they can afford it. She is not old enough for medicare and does not qualify for medicaid. Crappy situation really. According to the MD she really wont be getting better, she hates taking the lactulose and is very uncomfortable with all the loose stools.  The husband wants her to take it and she want s to do what he wants because she loves him and wants him to be happy.

It sounds like a sad situation ... the use of lactulose does not fix the underlying problem of liver failure, and is only short-term.

You could still advocate for the patient and try to get the hospice consult - sometimes they have ways of getting things for financial hardship situations. At least give hospice a shot - the worst they can say is no.

Does the husband understand the disease process and that his wife is going to die soon? Might be time to have that conversation with him, as difficult as that is. Approach an R.N. supervisor and get some direction first, then go from there. Continue to be supportive of the patient and the family - you are a good nurse and doing the best you can.

God bless and take care, friend.