How lactulose works in hepatic encephalopathy?

Hepatic encephalopathy (HE) is a condition where the liver of an individual isn’t working as effectively it should be. This condition compels the liver to accumulate toxins, which then cause damage to brain cells. HE severely affects a person’s cognitive function and can even lead to death if left untreated. Currently, there are numerous treatments for this ailment, ranging from medications to lifestyle changes.

However, one medication that stands out in treating HE is lactulose. It has been widely used over time but still leaves many curious about its effectiveness in managing hepatic encephalopathy.

In this article we will explore:

  1. An Overview of Lactulose
  2. What Exactly Causes Hepatic Encephalopathy?
  3. Symptoms of Hepatic Encephalopathy
  4. Diagnosis and Treatment Options for Hepatic Encephalopathy
  5. The Mechanism Behind Lactulose Action
  6. Why Consume Lactulose Instead of Other Treatments?
    7-10: Additional Benefits Of Consuming Lactulose To Improve Digestion Through Microbes And Gut Heath
    11: Potential Side Effects That Come with Taking Too Much or Inappropriate Usage.
    12-14 Dosages For Different Stages Of Hepatitis

Let’s dive right into some facts!

An Overview of Lactulose


From ancient times, when people didn’t have access to modern medicine like we do today, they depended on nature’s plant materials such as dates due to their having high concentrations sugar levels similar to lactoluse[ref]. But recently my dear readers you don’t need any date since most pharmacies sell solutions containing lactulosic acid³.

Lactulose is {an ore-sourced synthetic} disaccharide that escapes digestion within the gut. It is not digested or absorbed by the small intestine; instead, it goes into the colon, where microbes then ferment and metabolize this lactulose to lactic acid through a process known as acidification.

This special feature makes lactulose an ideal treatment for hepatic encephalopathy since most toxins that accumulate in HE accrue in the gut before getting transported to other parts of the body.

What Exactly Causes Hepatic Encephalopathy?

HE is mostly observed among patients with liver cirrhosis. However, any underlying condition capable of affecting normal liver function can also lead to encephalopathy.

The rise in ammonia levels within our bloodstream results from increased protein breakdown due to ineffective functioning by damaged livers #ref\pogorelyy_2018). This high toxicity level causes confusion, stupor or even coma[,via%20a%20permeant.%5D

To prevent further brain cell damage leading to various cognitive and behavioural impairments like sleep disturbances^1 fatigue, irritability ,and anxiety which often accompany such neurological disorders.

Symptoms of Hepatic Encephalopathy

Hepatic encephalopathy symptoms differ widely depending on factors like severity, source yet some frequent presentations include:

  • Personality changes
  • Amnesia
  • Incoherent speech pattern

Other common signs may include but are not limited to:

Increased aggression
Twitching Muscles

Just know my dear reader none of these symptoms will save you as COVID has taught us all…

Diagnosis and Treatment Options for Hepatic Encephalopathy

A thorough case history and physical examination by a clinician can help to confirm the presence of HE. A blood test is carried out, where high levels of ammonia may be indicative or present.

-First line treatments for hepatic encephalopathy are lactulose, which serves as an ammonia-scavenging agent, and rifaximin helps reduce toxin-producing gut flora[] .

-Liver transplant stands out as another treatment option even though it’s mostly reserved for those with end-stage liver disease.

The Mechanism Behind Lactulose Action

When one takes lactulose orally, some inactive particles called disaccharides accumulate within their intestine wall. Undigested carbohydrates rush into the intestines in large amounts causing bacteria to ferment them^3(Reid et al., 2008)2 thereby eventually producing lactic acid + acetic acid in small quantities.

Ammonia atoms are known as late bloomers that have;’succeeded’ this far without little oversight.’ #ref because they go undetected inside our bodies due to poor transportation across membranes at physiological pH conditions. These useless players/atoms hence build up within intestinal fluid until they get transported back via the generation of protons after bacterial metabolism [].

At this point my dear readers there is a secret twist in action!’ Since our waste disposal units -livers/cleaners- cannot consolidate these waste entities,(ammonia ions), lactulose comes “to clean things up” by trapping ions/’minor celebrities’ caused during bacterial fermentation thereby reducing its concentration^4 Geraghty et al., 1987)^which acts like filtering water !

Why Consume Lactulose Instead of Other Treatments?

We all know how hard it can be to choose the right medication. Let’s dig into some of the reasons why we believe lactulose should be the treatment of choice for hepatic encephalopathy.

  • It is an oral medication that can rapidly improve HE symptoms like confusion, sleep disturbance, and others.
  • Lactulose is known to cleanse toxic substances in gut flora caused by ineffective liver function.
  • Lactulose has shown efficacy as secondary prevention for those with recurrent/negative hepatitis[]
  • It can help manage constipation apart from its role in ameliorating hepatic encephalopathy| [ref]

Additional Benefits Of Consuming Lactulose To Improve Digestion Through Microbes And Gut Heath

Apart from being a go-to drug when it comes to treating hepatic encephalopathy, lactulose has also been linked with facilitating healthy digestion within our intestines by promoting beneficial microbial growth.

1.Lacatoluse ensures prompt nutrient absorption².

2.In other research studies,it was discovered injecting lactoose impacts mitochondrial behavior,[3] which translates directly into proper digestive functioning….

3.Ammonia scavenging agents arguably reduce flatulence therefore individuals who opt not use other medications see an aid in managing bowel gas .

Potential Side Effects That Come with Taking Too Much or Inappropriate Usage.

As you seek relief via consuming lactulosic acid solutions³ without direct medical advise,you may end up experiencing various side effects such as:

-Frequent diarrhea
– Flatulence – this typically lasts up until bacterial metabolism becomes regulated by regular consumption doses over time
additional note taking laxatives alongside prescribed treatment could worsen diarrheah hence negate affirmative action .

-Abdominal pain / stomach cramps

An overdose on this ‘drug’ may lead to severe dehydration and electrolyte imbalances if left untreated. This is due to the amount of water present within the colon being sucked out via osmosis.

So, it’s important not to take more medication than prescribed or recommended by a doctor.

Dosages For Different Stages Of Hepatic Encephalopathy

Moderate HE case onset |improvement noted 3-4 days after begining lactoluse administration 60ml/day[ ref]
Acute episodes|–no need for dosage adjustment usually occurs during hospitalization

Chronic portal blood flow obstruction will require additional lactulose therapy

ref: []

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