Lecture Notes on Lactulose (Brand Name: Colac)

Therapeutic Uses

• Laxative Effect: Primarily used to relieve constipation.
  • Memory aid: Lactulose works as a laxative.
• Ammonia Reduction: Main use is to decrease ammonia levels in patients with liver cirrhosis.
  • Ammonia is a toxin; excessive amounts can cause brain dysfunction, such as:
    • Hepatic encephalopathy
    • Confusion
    • Sleepiness
    • Coma

Mechanism of Action

• Ingestion of Lactulose:
  • Ammonia is pulled from the bloodstream to the colon.
  • Leads to rapid onset of diarrhea.
  • Memory aid: "lacta loose" - loosens the bowels.
• Excretion:
  • Ammonia is excreted through stool, reducing serum ammonia levels to a therapeutic range.

Side Effects

• Loose Stools: Causes abdominal pain.
• Dehydration:
  • Results from diarrhea.
  • Symptoms include dry mouth, thirst, and low urinary output.
• Electrolyte Imbalances:
  • Can cause muscle twitching and cramping.
  • May lead to increased heart rate or dysrhythmias as the body compensates for dehydration.

Patient Education and Nursing Considerations

• Diet Modifications:
  • Increase natural dietary fibers: fruits, vegetables, grains, beans.
  • Increase fluid intake.
  • Memory aid: "Fluids, fiber, and fruits fill up the toilet" - helps with constipation.
• Monitoring:
  • Check ammonia levels (lactulose should decrease these).
  • Track number of stools (2-3 soft bowel movements per day is expected).
  • Monitor for dehydration and mental status improvements.
  • Mental status should improve as serum ammonia levels decrease.

Key Takeaways

• Lactulose should:
  • Produce 2-3 bowel movements each day.
  • Decrease serum ammonia levels.
  • Improve mental status.

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