Q: 25 year old female is admitted to ICU with acute Acetaminophen toxicity. Patient is extremely lethargic and appears to be in acute hepatic encephalopathy. Resident decided to try lactulose to see if "intubation" can be saved by improving hepatic encephalopathy via lactulose. Simultaneously liver team is evaluating patient for possible transplant. What should be your next step?


Answer:  Stop administration of lactulose 

Benefits of lactulose in acute hepatic encephalopathy is not defined, rather it can be harmful. Lactulose can cause significant bowel distension which may hamper liver transplantation. Intubation in such situations is a safer approach, particularly when plans for surgery are underway.


Reference: 

Alba L, Hay JE, Lee WM. Lactulose therapy in acute liver failure. J Hepatol 2002; 36:33A.