Emergency treatment of portal-systemic encephalopathy with lactulose enemas. A controlled study.

SummaryLactulose enemas lowered blood ammonia and reversed clinical and EEG manifestations in 30 out of 34 episodes of acute portal-systemic encephalopathy (PSE) in 18 patients with liver cirrhosis. The results became apparent within hours and depended on effective acidification of the colon; the obtained decrease in blood ammonia was most impressive in patients with the highest pretreatment blood ammonia levels. The observed characteristics of the working of lactulose enemas can be easily explained by the process of acid dialysis. The procedure was well tolerated and no complications occurred. Lactulose enemas are indicated for prompt control of acute episodes of PSE, when oral therapy is not feasible or by itself insufficient to control hyperammoniemia.