Gastrointestinal System Disorders Q 240

---

Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in the client with hepatic encephalopathy?

  

    A. Passage of two or three soft stools daily

    B. Evidence of watery diarrhea

    C. Daily deterioration in the client's handwriting

    D. Appearance of frothy, foul-smelling stools

    

    

Correct Answer: A. Passage of two or three soft stools daily.

---

Lactulose reduces serum ammonia levels by inducing catharsis, subsequently decreasing colonic pH and inhibiting fecal flora from producing ammonia from urea. Ammonia is removed with the stool. Two or three soft stools daily indicate the effectiveness of the drug. Lactulose, also known as 1,4 beta galactoside-fructose, is a non-absorbable synthetic disaccharide made up of galactose and fructose. The human small intestinal mucosa does not have the enzymes to split lactulose, and hence lactulose reaches the large bowel unchanged. Lactulose is metabolized in the colon by colonic bacteria to monosaccharides, and then to volatile fatty acids, hydrogen, and methane.

---

Option B: Watery diarrhea indicates overdose. Since its intended use is to soften the stool quantity and increase the stool amount, its most significant side effect remains diarrhea. The diarrhea is dose-dependent and decreases in severity with a reduction in the dose of lactulose.

Option C: Daily deterioration in the client’s handwriting indicates an increase in the ammonia level and worsening of hepatic encephalopathy. From a pharmacokinetic standpoint, lactulose has negligible systemic absorption. However, like most laxatives, it has a propensity to bring about large changes in the body’s fluid and electrolyte status. This activity would require periodic electrolyte monitoring, especially in the elderly and critically ill population.

Option D: Frothy, foul-smelling stools indicate steatorrhea, caused by impaired fat digestion. Because lactulose has insignificant absorption by the gut and undergoes rapid excretion by the kidneys, its effects remain localized to the gut microenvironment.

---