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05/13/2012 06:51 PM

Lactulose Not Working?

Daughter99
Posts: 1
New Member

Hello everyone,

My father was recently diagnosed with liver disease, after years of heavy drinking. This is a very new diagnosis, delivered during a few ER visits that resulted in hospital stays, and he hasn't even had a regular appointment with the liver doctor yet (scheduled for this week), so we don't know everything yet.

He was sent home with a prescription for lactulose after his first ER visit. I do think he failed to take it properly that time (in large part due to no real explanation or stressing of its importance coming from the hospital), which led to him growing increasingly disoriented and winding up back in the hospital. This time, his care has been MUCH better, and he was sent home in much better shape from the hospital, with a lot more followup care. I really thought we'd do much better this time. Unfortunately, after 3 days, I think we're headed back downhill.

He has not had a bowel movement at all today, which has made him weaker and less talkative (that seems the best way to describe it. He's not disoriented yet. But he's not as "with it" as he was.). The thing is, he has been taking the lactulose. A lot. In an attempt to force a bowel movement, he has taken about 5 doses today. And still no action.

The hospital said that the lactulose they prescribed for home is the same thing they were giving at the hospital, even though the color is different. I just don't understand how he had near uncontrollable trips to the bathroom (resulting in diapers, to his horror) which put him in EXCELLENT mental shape at the hospital, but the second he gets home, the bathroom trips slow to a halt, when he is still taking the same medication. I just don't know where we're going wrong here.

I do think there is some problems with the diet. My parents do not cook much, and typically dine out, but since he is now on a low-sodium diet (not to mention, his fear of having a bathroom accident at a fine dining establishment), they can't really do that. Their form of "cooking" (lots of fruit, bread and butter, grape nuts with milk) probably does not really constitute a good diet, though he has been drinking Boost shakes to hopefully help with vitamins etc. Again, this is all very recent, so we're trying to fix these problems as they come. I plan on looking around tomorrow morning for a private chef service, so that someone can come and prepare him low sodium meals, which I do think will help.

Obviously, we will also call his primary physician and home health care nurse tomorrow. But I was hoping people here will be of greater assistance, or at least offer some anecdotal reassurance. I am guessing the advice from the doctor and nurse will be to stick with the lactulose. Which we, of course, will. But can anyone offer any guesses as to why it is not really working? Anything we can do to improve its efficiency?

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05/14/2012 03:56 AM
MommaMac
MommaMac  
Posts: 1621
Senior Member

My husband was recently diagnosed, as well. Have gone the similar route with ER diagnosis and hospital stays and trips back to the ER. Lacutalose seems to have two amounts prescribed. Most persons take 30 ml, three times daily. My husband is on 15 ml three times a day. What was not explained well is titrate. That means, after the three doses, keep taking a spoonful every hour until a BM happens. Sounds like your father did what was needed. Also look to what else may cause constipation. Jim was home from the hospital for three days before his first BM. Now, he has at least one a day. Diet is important. Hopefully today, things will work out. This board has been a wealth of support for me. Prayers for you and your family.

Jackie


05/14/2012 05:50 AM
krishemp
 
Posts: 201
Member

Hi there, and welcome to the group. Get your father to see a liver specialist asap. My mother is also on lactulose (alcoholic cirrhosis) and had been taking it for years, this year though, it is not as effective as it used to be and no longer works enough on its own. There is an antibiotic called xifaxin that is used to treat HE (hepatic encepalopathy - the confusion you described) I tell y ou this stuff works wonders.

Please see the member site www.mysickliver.weebly.com. It has easy to understand explainations of signs, symptoms and complications and what you need to look for.

Best of luck to you. This site is a great resource.


05/14/2012 08:07 AM
mpmom
mpmom  
Posts: 3278
VIP Member
I'm an Advocate

Daughter99

The other gave you good advice. This isn't a easy road by any means.

Have them list you on HIPPA forms so that you can get information from the Drs.

Keep copies of ALL test results, It helps you track his progress.

You stated he was a heavy drinker. Has he stopped completely? If he has he should recover some function. It takes a long time (Often a couple of years) But it's very common to see amazing recovery if alcohol is completely removed forever. Alot depends on the damage done.He must remain alcohol free for 6 months to qualify for transplant.

Even Cirrhosis patients can live a very long relatively normal life.

You need to monitor his labs (Bilirubin, Albumin ,Creatinine, INR, Platelets especially)

He also should be monitored for Ascites.

With the above labs you can figure his CTP score

http://www.mdjunction.com/cirrhosis/articles/what-is-the- ctp-score

And his MELD score

http://optn.transplant.hrsa.gov/resources/ MeldPeldCalculator.asp?index=98

Do check out our web site mentioned above by krishemp there is a lot of information there

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