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
Side effects of lactulose may include:
- Stomach cramps.
- Diarrhea.
- Intestinal gas.
- Itching.
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.
References
Citations
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.
Credits
| Author | Caroline Rea, RN, BS, MS |
| Editor | Maria Essig |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Pat Truman, MATC |
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Specialist Medical Reviewer | Steven L. Flamm, MD - Gastroenterology |
| Last Updated | January 25, 2008 |
