Drug Study: Lactulose

(Duphalac, Lilac)
Classification: Laxative
Action: Causes an influx of fluid in the intestinal
tract by increasing the osmotic pressure within
the intestinal lumen. Bacterial metabolism of the
drug to lactate and other acids which are only
partially absorbed in the distal ileum and colon
augments the osmotic effect of lactulose. The
distention of the colon due to increased fluid
enhances intestinal motility and secretion.
These result to the passage of soft stools.
Decrease in the lumenal pH (due to bacterial
metabolism) further increase motility and
secretion. Lactulose also lowers intestinal absorption of ammonia
presumably due to increased utilization of ammonia by intestinal bacteria.
Indication: Constipation, salmonellosis. Treatment of hepatic
encephalopathy.
Adverse Reactions: Abdominal discomfort associated with flatulence and
intestinal cramps. Nausea, vomiting, diarrhea on prolonged used.
Nursing Considerations
Assessment

Assess patients condition before therapy and reassess regularly

thereafter to monitor drugs effectiveness. Identify cause of constipation:
Assess lifestyle in relation to fluids, bulk and exercise

For patient with hepatic encephalopathy, regularly assess mental

condition (clearing of confusion, lethargy, restlessness, irritability) and
ammonia level (30-70 mg/100 mL).

Monitor for possible adverse GI reaction: nausea,

vomiting, abdominal cramps, belching, diarrhea, flatulence and distension.

Monitor fluid and electrolyte status: urine output, input-output ratio to

identify fluid loss, hypokalemia and hypernatremia.

Monitor for increased glucose levels in diabetic patients.

Assess patients and familys knowledge of drug therapy.

Nursing Diagnoses

Constipation related to underlying condition

Diarrhea related to adverse drug reaction

Fluid and electrolyte imbalance related to adverse GI reaction
Knowledge-deficit related to drug therapy
Noncompliance

Planning

Oral route
o
Give with full glass of fruit juice, water, milk to increase
palatability of oral form; increase fluids by 2 L/day; do not give with
other laxatives; if diarrhea occurs, reduce dosage.

Rectal route
o
Administer retention enema by diluting 300 mL of lactulose/700
mL of water or 0.9% NaCl; administer by rectal balloon catheter; retain
for 30-60 minutes; repeat if evacuated too quickly.
Implementation

Advice patient to dilute drug with juice or water or take with food to
improve taste
Teach patient that normal bowel movements do not always occur daily
and that adequate fluid consumption is necessary
Inform patient of possible adverse effects and the need to notify
physician immediately if these occurs. Remind patient not to use in
presence of abdominal pain, nausea and vomiting.
Instruct patient to notify physician if constipation is unrelieved or
symptoms of electrolyte imbalance occur; muscle cramps, pain, weakness,
dizziness and excessive thirst
Inform patient that bowel tone may be lost if used as laxative for long
term therapy. Do not give at bedtime because it may interfere with sleep.
Inform patient that diarrhea may indicate over dosage.