A patient with liver failure is taking lactulose (Chronulac). Which laboratory data indicates that the medication is having the desired effect?
1. increased serum ammonia level
2. decreased serum ammonia level
3. increased serum ALT level
4. decreased serum ALT level
Correct Answer: 2
Ammonia, a toxic by-product of protein metabolism, is converted to urea in the liver for elimination by the kidneys. Lactulose works by acidifying the contents of the bowel, which has the effect of keeping ammonia in the bowel, where it is excreted from the body in the stools, rather than being reabsorbed into the circulation. This medication should lower the serum ammonia level. It has no effect on the ALT level.
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