When the liver has been damaged by
cirrhosis, it may not effectively filter poisons from
the bloodstream, especially substances in the blood produced by bacteria in the
large intestine. As a result, these substances (which include ammonia) may
build up in the bloodstream and cause changes in mental function (encephalopathy). High ammonia levels in the blood may
indicate encephalopathy that is present or likely to develop.
Most cases of encephalopathy are treated using a medication called
lactulose, which helps prevent the buildup of substances in the large intestine
that may lead to encephalopathy. Lactulose is effective at decreasing ammonia
levels in the blood and improving encephalopathy in 80% of the people who
receive appropriate doses of it.1
There is some evidence that an artificial sweetener called lactitol
may be as effective as lactulose but may cause fewer side effects and may taste
better than lactulose.2 Lactitol is not yet
approved for use in the United States.
Bataller R, Gines P (2005). Cirrhosis of the
liver. In DC Dale, DD Federman, eds., ACP Medicine,
section 4, chap. 9. New York: WebMD.
Fitz JG (2006). Hepatic encephalopathy,
hepatopulmonary syndromes, hepatorenal syndrome, and other complications of
liver disease. In M Feldman et al., eds., Sleisenger and
Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp.
1965-1991. Philadelphia: W.B. Saunders.
Caroline Rea, RN, BS, MS
Susan Van Houten, RN, BSN, MBA
Pat Truman, MATC
Primary Medical Reviewer
Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer
Steven L. Flamm, MD - Gastroenterology
January 25, 2008
WebMD Medical Reference from Healthwise
January 25, 2008
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