Lactulose and MOM?

[BrazoriaLVN]

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?

[OnlybyHisgraceRN, ASN, RN]

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ahfs consumer medication information.

[h=1]lactulose(lak' tyoo lose)[/h]last reviewed: september 1, 2010.

[h=2]why is this medication prescribed?[/h]lactulose is a synthetic sugar used to treat constipation. it is broken down in the colon into products that pull water out from the body and into the colon. this water softens stools. lactulose is also used to reduce the amount of ammonia in the blood of patients with liver disease. it works by drawing ammonia from the blood into the colon where it is removed from the body.

this medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

i underlined the answer to your question. i would not mix it with mom, you can ask for mom as an adjunct to facilitate bm.

[BrazoriaLVN]

Thanks, but I know how lactulose works. What I'm asking is in the absence of a bm after giving lactulose, would mixing MOM with the lactulose somehow negate the ammonia lowering effects of the lactulose or help it along?

[klone, MSN, RN]

Only lactose laxatives pull ammonia from the blood. I believe MoM is a saline/osmotic, rather than a lactose laxative, so it works by a different mechanism. Also, according to the great Wikipedia, saline laxatives work mainly in the small/large intestine, and lactose laxatives work mainly in the colon.

[RoyalPrince]

No, do not mix. it might have BM but lactulose therapy is whats needed not MOM. It pulls away water as well.

[loriangel14, RN]

I am surprised the MD only ordered one dose. We have a pt on the floor right now with the same issue and he gets 30mls TID.

I agree with the other posters, do not mix with MOM.

[BrazoriaLVN]

Well, a one time extra dose. He gets 75mL QID!

[RockinChick66]

Whether its ordered TID or Qid, the goal is to have 3 BMs per day. If the pt has had 3 BMs after 1 or 2 doses of lactose, I get an order to hold the rest of the doses for that day. That's why I believe liver pts are so non compliant with lactulose, they drink it as ordered and start BM'ing so much that they get miserable. Pt teaching is important when administering lactulose. As far as the MoM question, I don't know. I wouldn't think it would work like you think.

[Salisburysteak, BSN, RN]

I worked with a resident that has liver problems and he was getting 45ml Lactulose 4x daily with a daily dose of MOM and a PRN order for MOM. I have never mixed MOM and Lactulose together. He had other issues like not wanting to get out of bed or bathing on a regular basis. He was lazy that way. We knew when his Ammonia levels were increasing because he would actually get out of bed and want a shower. Pretty strange how the body and mind works!

[KelRN215, BSN, RN]

I have given lactulose as frequently as q 2hr to facilitate BMs in patients who were either severely constipation or had high ammonia levels. I agree that I would not mix MOM with it, especially not without an order to do so.

[eleectrosaurus]

If i am reading this right lactulose via enema is a bit more effective.

oral+enema even more so.

http://www.kfshrc.edu.sa/annals/03-052.pdf