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Lactulose Enemas

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▸Address requests for reprints to Edward S. Kersh, M.D., Department of Cardiology, Pacific Medical Center, San Francisco, Calif. 94120.

Bronx, New York

Ann Intern Med. 1973;78(1):81-84. doi:10.7326/0003-4819-78-1-81
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Four patients with hepatic encephalopathy were treated with lactulose (4-O-β-D-galactopyranosyl-D-fructose) administered by retention enema. All patients showed dramatic improvement in clinical grade of coma within 12 hours. Arterial ammonia and cerebrospinal fluid ammonia levels showed a marked decline; the pH of the stool also decreased. Since ammonia transport in the colon is a pH-dependent system, it was believed that colonic acidification by lactulose was responsible for these effects. The pH of the lactulose solution itself was 3.8, and we concluded that the effects were a direct result of colonic irrigation with an acid solution.





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