A client with hepatic encephalopathy is receiving lactulose. Which assessment provides the nurse with the best information to evaluate the client’s therapeutic response to the drug?
A.
Stool color and character.
B.
Serum electrolytes and ammonia.
C.
Serum hepatic enzymes.
D.
Fingerstick glucose.
The Correct Answer and Explanation is:
Correct Answer: B. Serum electrolytes and ammonia.
Explanation:
Hepatic encephalopathy is a complex neuropsychiatric syndrome that occurs as a result of severe liver dysfunction, leading to the accumulation of toxic substances in the blood, particularly ammonia. Ammonia is a byproduct of protein metabolism, and in a healthy liver, it is converted into urea and excreted through urine. However, in clients with significant liver disease, such as cirrhosis, the liver’s ability to detoxify ammonia is impaired, leading to its accumulation in the bloodstream. Elevated ammonia levels are strongly associated with the development of hepatic encephalopathy, which can range from subtle cognitive changes to profound coma.
Lactulose, a synthetic disaccharide, is the primary treatment for hepatic encephalopathy. It works by several mechanisms:
- Reduction of Ammonia Absorption: Lactulose is metabolized by colonic bacteria into lactic acid, which lowers the pH in the colon. The acidic environment converts ammonia (NH3) into ammonium (NH4+), which is less absorbable and is excreted in the stool.
- Increased Stool Frequency: Lactulose also acts as an osmotic laxative, promoting more frequent bowel movements. This helps eliminate ammonia and other toxins from the gut.
To evaluate the therapeutic response to lactulose in a client with hepatic encephalopathy, the best assessment is to monitor serum ammonia levels and serum electrolytes. A decrease in serum ammonia levels indicates that lactulose is effectively reducing the ammonia load, thereby improving the symptoms of hepatic encephalopathy. Additionally, monitoring serum electrolytes is crucial because lactulose-induced diarrhea can lead to electrolyte imbalances, such as hypokalemia, which need to be managed to prevent complications.
The other options, such as stool color and character, serum hepatic enzymes, and fingerstick glucose, do not provide direct information about the effectiveness of lactulose in reducing ammonia levels or improving hepatic encephalopathy. Therefore, Option B is the most relevant assessment to determine the client’s therapeutic response to lactulose.