So we have a patient with end-stage cirrhosis that always gets back critical ammonia levels. A few days ago he was really woozy and sure enough is ammonia came back at 109. MD ordered another dose of lactulose now and check labs later. My question is, if the method of action of lactulose is ridding the body of excess ammonia by bowel movements, would any laxative work? After the extra dose of lactulose I gave the pt still hadn't had a bm after 8 hours. My coworker said to mix MOM in it next time to get it working faster but I'm not sure if that would work and I'm not comfortable doing it without an order anyway. What do yall think?