Sunday, January 25, 2015

Lactulose removes ammonia ions from the gut by:


Lactulose removes ammonia ions from the gut by:


a. Being converted to lactic acid by colonic bacteria; this acidifies the feces, resulting in the trapping of ammonia as ammonium in the stool.
b. Causing ammonia to be transmitted to the intracellular region through the sodium–potassium membrane
pump, where it is safely used in the tricarboxylic acid cycle.
c. Forcing renal excretion of chloride, leading to compensatory hyperpnea and respiratory alkalosis, which keeps
ammonia nontoxic.
d. Providing a protective coating on the gut’s brush border, which blocks ammonia absorption.
e. Mycelizing preammonia prior to its harmonic conversion.


The answer is a. Lactulose is a poorly absorbed sugar metabolized by colonic bacteria yielding lactic acid. The salutary effects of this agent are related both to the acidification of the fecal stream, resulting in the trapping of ammonia as ammonium in the stool, and to its cathartic action. The usual dosage of lactulose is 15–30 mL orally 3 or 4 times daily or in a quantity sufficient to result in several loose bowel movements daily. The principal adverse effect is excessive diarrhea, with resultant fluid and electrolyte imbalance.

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