Lactulose everything you need to know Mechanism of action uses

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Lactulose: Mechanism of Action and Dosage • #### Mechanism of Action • Lactulose is a synthetic disaccharide used primarily in the treatment of constipation and hepatic encephalopathy. It consists of two monosaccharides: galactose and fructose. • 1. *Constipation:* • *Osmotic Effect:* Lactulose is not absorbed in the small intestine and reaches the colon unchanged. In the colon, it is metabolized by bacterial flora into short-chain fatty acids (such as lactic acid and acetic acid), which increase the osmotic pressure within the colon. This process draws water into the bowel lumen, softening stools and promoting bowel movements. • *Stool Softening:* The increased water content softens stools and increases their bulk, facilitating their passage through the colon. • 2. *Hepatic Encephalopathy:* • *Reduction of Ammonia Production:* In patients with liver disease, the liver's ability to detoxify ammonia is impaired. Ammonia is produced by the gut bacteria from dietary proteins and other sources. Lactulose lowers the pH in the colon, creating an acidic environment that converts ammonia (NH3) to ammonium (NH4+), which is less readily absorbed into the bloodstream. • *Alteration of Gut Flora:* The acidic environment favors the growth of non-urease-producing bacteria over urease-producing bacteria, reducing ammonia production. • *Cathartic Effect:* The increased bowel movements also help in the excretion of ammonia and other nitrogenous waste products from the body. • #### Dosage • 1. *Constipation:* • *Adults:* The typical initial dose is 15-30 ml (10-20 grams) once daily, which can be adjusted to 15-45 ml (10-30 grams) daily as needed. Maintenance doses are usually between 15-30 ml (10-20 grams) daily. • *Children:* Dosage varies by age. For example: • Children 1-6 years: 5-10 ml (3.3-6.7 grams) daily. • Children 7-14 years: 10-15 ml (6.7-10 grams) daily. • 2. *Hepatic Encephalopathy:* • *Adults:* The initial dose is typically 30-45 ml (20-30 grams) three to four times daily. The dose is adjusted to produce two to three soft stools per day. • *Acute Episodes:* Higher doses may be required initially, and administration every hour can be necessary to achieve the desired effect. • #### Administration • Lactulose can be taken with or without food. • It is often recommended to mix the solution with fruit juice, water, or milk to improve palatability. • Regular monitoring of electrolytes is necessary, especially in long-term use, due to the risk of electrolyte imbalance from frequent bowel movements. • Side Effects • Common side effects include bloating, flatulence, and abdominal discomfort. • Overdosage can lead to diarrhea and electrolyte disturbances. • Long-term use should be monitored by a healthcare provider to avoid complications. • Lactulose is an effective and widely used medication for both constipation and hepatic encephalopathy, with a well-established safety profile when used appropriately. • #lactulose #medicalstudent #facts #medicine #resident

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