A client with cirrhosis and hepatic encephalopathy is receiv… | MyMerci
Medical EmergenciesPA
Question
A client with cirrhosis and hepatic encephalopathy is receiving lactulose 30 mL PO TID. Which outcome best indicates effective therapy?
1Watery diarrhea 10 times per day
22-3 soft stools per day with improved mental status and decreasing serum ammonia✓ Correct answer
3Constipation with one stool every 2-3 days
4No bowel movements with stable ammonia
Explanation
Correct (2): Lactulose targets 2-3 soft stools per day — this clears ammonia-producing bacteria and acidifies the colon to trap NH4+. Effective therapy is reflected in improved mental status and decreasing ammonia. (1) Under-treatment. (3) Over-treatment risks dehydration. (4) Not effective.
In-depth explanation
Memory Tip Lactulose = "2-3 stools/day, alert mind, lower ammonia." Combined with rifaximin for recurrent hepatic encephalopathy.
Clinical scenario
Scenario 62-year-old male with cirrhosis and hepatic encephalopathy on lactulose 30 mL PO TID. Baseline ammonia 110, confusion grade 2.