Question

The client with cirrhosis of the liver is receiving Lactulose. The nurse is aware that the rationale for the order for Lactulose is: A. To lower the blood glucose level B. To lower the uric acid level C. To lower the ammonia level D. To lower the creatinine level

Short answer

Answer: Lactulose is ordered for a client with cirrhosis of the liver to lower the ammonia level, as it helps treat hepatic encephalopathy by trapping ammonia in the feces and allowing the body to expel the toxins effectively.

Step-by-step solution

Understanding Cirrhosis of the Liver

Cirrhosis is a chronic liver disease that results from the continuous damage to liver cells. In cirrhosis, the liver cells get replaced by scar tissue, making the liver unable to perform its functions properly. Some of these functions include detoxification, protein synthesis, bile production, and maintaining proper levels of nutrients and chemicals in the blood.

Understanding Lactulose

Lactulose is a synthetic sugar used to treat constipation. It works by drawing water into the bowel, softening the stool, and promoting bowel movements. Apart from treating constipation, Lactulose can also be used to treat hepatic encephalopathy, a condition that can arise from cirrhosis of the liver. Hepatic encephalopathy occurs when the liver cannot process toxins like ammonia, leading to a build-up of these toxins in the blood and, subsequently, the brain. This can cause confusion, disorientation, and even coma. Lactulose works by trapping ammonia in the feces, allowing the body to expel the toxins effectively and lower the ammonia levels in the blood.

Analyzing the Given Options

Now that we understand the purpose of Lactulose, we can analyze the given options: A. To lower the blood glucose level - This is incorrect, as Lactulose is not used to lower blood sugar levels. B. To lower the uric acid level - This is incorrect, as Lactulose does not have an effect on uric acid levels. C. To lower the ammonia level - This is the correct answer. Lactulose is used to treat hepatic encephalopathy by lowering the ammonia levels in the blood. D. To lower the creatinine level - This is incorrect, as Lactulose has no direct effect on creatinine levels. Creatinine levels are related to kidney function, not liver function.

Conclusion

Based on our understanding of Lactulose and its effects on the body, particularly in the context of cirrhosis of the liver, the correct rationale for the order of Lactulose is: C. To lower the ammonia level.

Key concepts

Hepatic Encephalopathy Treatment

Hepatic encephalopathy is a significant complication of liver cirrhosis that leads to brain dysfunction due to the liver's inability to remove toxins from the blood. Treatments for this condition aim to reduce the production and absorption of these toxins, primarily ammonia, which can impair brain function.

Lactulose, a synthetic disaccharide, plays a crucial role in treating hepatic encephalopathy. It is not absorbed in the gut and works by acidifying the contents of the bowel, which helps trap and expel ammonia from the body through feces. Furthermore, Lactulose can also reduce the absorption of ammonia by altering bacterial metabolism in the gut. As a result, this medication decreases blood ammonia levels, which can help reverse the symptoms of hepatic encephalopathy, ranging from mild confusion to even coma in severe cases.

Cirrhosis Liver Function

Cirrhosis is the advanced scarring of the liver, a culmination of continuous liver damage due to conditions such as chronic alcoholism or hepatitis. This scarring affects the liver’s ability to perform critical functions — from producing proteins and bile to removing toxins and playing its part in metabolism.

The progression of cirrhosis impedes liver function, leading to serious complications. One such complication is the buildup of toxins like ammonia. Normally, the liver would convert ammonia into urea, a less harmful substance which is then excreted by the kidneys. However, in cirrhosis, the liver's impaired function allows ammonia to accumulate, posing a risk for hepatic encephalopathy and necessitating intervention with treatments like Lactulose.

Ammonia Level Management

Ammonia is a normal byproduct of protein metabolism in the body. Typically, the liver converts ammonia into urea, which is safely excreted by the kidneys. In individuals with cirrhosis, however, the liver's capacity for ammonia detoxification is compromised.

High levels of ammonia can cross the blood-brain barrier and disrupt normal neurological function. Thus, managing ammonia levels is vital in patients with liver dysfunction. This is where medications like Lactulose come into play, by promoting the expulsion of ammonia through feces. This management is a cornerstone in the prevention and treatment of hepatic encephalopathy, essential for maintaining neurological wellbeing in individuals with compromised liver function.