Lactulose Therapy for Hepatic Encephalopathy: Patient Information, Exercises of Gastroenterology

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Lactulose Therapy in

Hepatic Encephalopathy

Patient Information Booklet

Department of Gastroenterology

and Hepatology

Liverpool Hospital

Lactulose

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TABLE OF CONTENTS

What is Hepatic Encephalopathy? ........................................................... 3

Symptoms of Hepatic Encephalopathy .................................................... 4

How does Hepatic Encephalopathy develop? .......................................... 5

How can Hepatic Encephalopathy be treated? ........................................ 6

Lactulose Therapy .................................................................................... 6

Useful Strategies when using Lactulose ................................................... 7

Avoiding or Reducing Hepatic Encephalopathy ....................................... 7

Additional Resources ................................................................................ 8

The aim of this booklet is to provide information about the importance of lactulose therapy for patients with Advanced Liver Disease and to provide information about how to prevent/reduce Hepatic Encephalopathy.

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SYMPTOMS OF HEPATIC ENCEPHALOPATHY

MILD

• Mood change or mild confusion
• Poor concentration and forgetfulness
• Problems with handwriting
• Poor judgement (especially when driving and/or when at work)
• Changes in sleep patterns (wide awake at night and sleeping during the day)

SEVERE – SECONDARY TO UNTREATED MILD SYMPTOMS

• Noticeable confusion with disorientation to place and time
• Aggression
• Drowsiness or tiredness
• Severe restlessness
• Slowed or sluggish movement
• Slurred speech
• Flapping tremor
• May develop coma or death

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HOW DOES HEPATIC ENCEPHALOPATHY DEVELOP?

The exact cause of Hepatic Encephalopathy is unknown. It is usually triggered by a build-up of toxins in the blood.

The liver removes unwanted toxins such as ammonia from our body. If the liver cannot successfully remove toxins from the blood, these toxins will eventually build up and may lead to Advanced Liver Disease, which can also be called ‘cirrhosis’. Cirrhosis can progress further into liver failure.

Hepatic Encephalopathy is a serious complication secondary to cirrhosis and a sign of liver failure.

Blood containing high concentrations of toxins reaches all areas of our body, including our brain. This causes brain cells to swell, resulting in Hepatic Encephalopathy and its associated symptoms.

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USEFUL STRATEGIES WHEN USING LACTULOSE

Problems Management

Too Sweet To improve taste, you can mix lactulose with juice, water, protein shake, lemon tea or a soft dessert.

Excessive diarrhoea or flatulence (^) After consultation with your health care provider, you may be able to adjust the dose of Strong stomach cramps lactulose.

Burping/Belching

Dehydration Be sure to keep your fluid intake up, however please check with your health care provider if you are on fluid restriction.

AVOIDING OR REDUCING HEPATIC ENCEPHALOPATHY

Have you had your lactulose dose today?

Take lactulose and other medications as prescribed

Discuss potential alternative treatments with your liver specialist if lactulose is ineffective

Attend all medical appointments on time

Maintain a healthy diet as advised by your local doctor/dietitian

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ADDITIONAL RESOURCES

More information regarding Hepatic Encephalopathy and lactulose can be found on the following websites.

1. Healthline – Lactulose, Oral Solution www.healthline.com/health/lactulose-oral-solution
2. Product Information: Lactulose Solution UK www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con 1039446.pdf
3. American Liver Foundation: Hepatic Encephalopathy https://liverfoundation.org/for-patients/about-the-liver/diseases-of- the-liver/hepatic-encephalopathy/
4. Product Information of Lactulose

http://www.guildlink.com.au/gc/ws/mylan/pi.cfm?product=gopdup ha

5. Australian Government: Department of Health Therapeutic Goods Administration https://search.tga.gov.au/s/search.html?collection=tga-websites- web&query=lactulose&op=Search

Date of publication: July 2019 Catalogue no.: 19/