Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
My Question Is Regarding Whether Administering A Very Large Dose
Question: My question is regarding whether administering a very large dose of Lactulose caused extreme bloating, bloody diarrhea, and death of my brother. At the Hospital that fateful weekend, 20G were given at 11:50pm on 831, 80MG were administered in four 20G dosages on 91 and another 20G dosage was given on 92. (Times not noted). 120Gs total to a patient who was only taking 10ML to 15ML of Lactulose per day. That night upon admission to ER, his ammonia levels were not even high enough to warrant this huge overdose of Lactulose. His ammonia level was 96 (range preference is 16 - 53 - so 96 is not that alarmingly high). He was very coherent, able to answer questions, not in the least bit confused nor was he experiencing Hepatic Encephalopathy. 20G x 6 dosages 120g in comparison to 15ML x 6 dosages 90ML and he was only taking 15ML per day if that.
I maintain that the overdose of Lactulose administered in the hospital caused my brothers immediate physical reaction and ultimate untimely death 17 days later. Warnings regarding using extreme care in administering Lactulose are stated over and over in the medical literature. Lactulose must be titrated up slowly and carefully. I have always understood the seriousness of this from the very first day that the Lactulose was prescribed for my brother 7 years ago. I trusted that the hospital would know this when I last said goodbye before they admitted him into the hospital that night after the ER visit.
I maintain that the overdose of Lactulose administered in the hospital caused my brothers immediate physical reaction and ultimate untimely death 17 days later. Warnings regarding using extreme care in administering Lactulose are stated over and over in the medical literature. Lactulose must be titrated up slowly and carefully. I have always understood the seriousness of this from the very first day that the Lactulose was prescribed for my brother 7 years ago. I trusted that the hospital would know this when I last said goodbye before they admitted him into the hospital that night after the ER visit.
Brief Answer:
160 ml plus is maximum permissible dose of lactulose.
More details required like what was the stage of encephalopathy,
Level of various ions like sodium potassium chloride etc,
Condition of liver.
Yes increased dose may cause bloating and diarrhea but it could easily be controlled by rehydrating the patient by oral rehydration solution or giving i.v drip.
Has the hospital not prescribed this?
Death due to diarrhea is caused generally due to lose of electrolytes however lactulose just loosens up already formed stool and expels it out.
Detailed Answer:
Hello and thank you for choosing "Ask a Doctor" service for your query my dear,
Firstly my heart felt sympathy with you and every ope in your family.
Unfortunately the maximum permissible doses of lactulose is about 160 ml in a day or a bit more but in rare cases severe hypernatremia (increased levels of sodium) is seen in patient on high doses.But as per you he was on 90ml doses per day for last few years and now before his demise he was on 120 so total difference in dose is only 30 ml(that too in a patient well adapted to lactulose) .
Though golden rule of medical science is that there is no rule....Secondly for detailed evaluation i would like to go through all his reports like his ammonia levels ,His liver reports everything for giving you a good professional suggestion.
For me an add on of 30 ml lactulose is highly unlikely to cause death in a patient who is on lactulose for years.
For any further professional explaination i would like you to attach complete case summary with levels of various ions etc.
May God bless and comfort you and your family during this difficult period again please accept my sincere condolences.
Regards!
160 ml plus is maximum permissible dose of lactulose.
More details required like what was the stage of encephalopathy,
Level of various ions like sodium potassium chloride etc,
Condition of liver.
Yes increased dose may cause bloating and diarrhea but it could easily be controlled by rehydrating the patient by oral rehydration solution or giving i.v drip.
Has the hospital not prescribed this?
Death due to diarrhea is caused generally due to lose of electrolytes however lactulose just loosens up already formed stool and expels it out.
Detailed Answer:
Hello and thank you for choosing "Ask a Doctor" service for your query my dear,
Firstly my heart felt sympathy with you and every ope in your family.
Unfortunately the maximum permissible doses of lactulose is about 160 ml in a day or a bit more but in rare cases severe hypernatremia (increased levels of sodium) is seen in patient on high doses.But as per you he was on 90ml doses per day for last few years and now before his demise he was on 120 so total difference in dose is only 30 ml(that too in a patient well adapted to lactulose) .
Though golden rule of medical science is that there is no rule....Secondly for detailed evaluation i would like to go through all his reports like his ammonia levels ,His liver reports everything for giving you a good professional suggestion.
For me an add on of 30 ml lactulose is highly unlikely to cause death in a patient who is on lactulose for years.
For any further professional explaination i would like you to attach complete case summary with levels of various ions etc.
May God bless and comfort you and your family during this difficult period again please accept my sincere condolences.
Regards!
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
