Abstract
To the Editor: Lactulose is an osmotic laxative prescribed for the treatment of hepatic encephalopathy (HE) and constipation. Although generally considered safe and innocuous, lactulose may be associated with several adverse events, including abdominal discomfort, abdominal distention, increased intestinal gas production, and flatulence (1,2). Diarrhea may also occur and may lead to more serious adverse events, including dehydration, hypokalemia, hypernatremia, and other electrolyte disturbances. Dehydration may worsen the mental status of patients with HE (3). Hypernatremia has been associated with dehydration and lactulose use in patients with HE (4,5,6) and may lead to acute kidney injury, which may precipitate hepatorenal syndrome. Overall, lactulose should be considered a drug with potential morbidity associated with its use (7).
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