Constipation lactulose

Constipation is a common symptom in the neurodegenerative disorders. Inadequate fluid intake, dysphagia, dysautonomia, and immobility aU contribute to constipation. Increasing fluid and fiber intake, along with increasing physical activity can help. Use of docusate sodium, milk of magnesia, dulcolax and senna may also improve symptoms. For severe constipation, lactulose, magnesium citrate and enemas can provide relief. 

Advising against the purchase of an old-fashioned medicine and guiding towards a better, evidence-based treatment. For example liquid paraffin is not considered to be the best treatment for constipation. Lactulose is the preferred treatment nowadays. 

Because many elderly persons experience constipation, laxative use is sometimes viewed as a normal part of daily life. However, mineral oil can be a special hazard in bedridden elderly persons because it can lead to pneumonia through inhalation of oil droplets into the lungs. Lactulose may be a better choice in this situation. Regular use of any laxative that affects fluid and electrolytes may result in significant unwanted adverse effects. 

For some bedridden or geriatric patients, or others with chronic constipation, bulk-forming laxatives remain the first line of treatment, but the use of more potent laxatives may be required relatively frequently. Agents that may be used in these situations include milk of magnesia and lactulose. 

Lactulose is a disaccharide that causes an osmotic effect retained in the colon. It is generally not recommended as a first-line agent for the treatment of constipation because it is costly and not necessarily more effective than agents such as milk of magnesia. It may be justified as an alternative for acute constipation and has been found to be particularly useful in elderly patients. 

Sorbitol, a monosaccharide, has been recommended as a primary agent in the treatment of functional constipation in cognitively intact patients. It is as effective as lactulose and much less expensive. 

Digoxin (cardiac glycoside) and trihexyphenidyl (antimuscarinic drug) must be used with caution in elderly patients. Low doses are recommended in elderly patients to avoid toxicity. Lactulose may be safely administered to elderly patients with constipation. 

Bisacodyl is a stimulant laxative that does not take long to act and is therefore useful in acute constipation. The bulk-forming laxative ispaghula husk takes longer to act when compared with bisacodyl but is useful for long-term administration. Lactulose, which is an osmotic laxative, has a lag time of about 48 hours before onset of action. Loperamide and kaolin and morphine mixture are antidiarrhoeals used in acute diarrhoea. 

Lactulose (Constulose, Generlac, Enulose, Others) [Laxative/ Osmetic] Uses Hepatic encqjhalopathy constipation Action Acidifies the colon, allows ammonia to diffuse into colon Dose Acute hepatic enc halopathy 30-45 mL PO qlh until soft stools, then tid-qid Chronic laxative therapy 30-45 mL... 

Gnest JF, Varney SJ. Pharmacoeconomic impact of low-dose macrogol 3350 plus electrolytes compared with lactulose in the management of chronic idiopathic constipation among ambnlant patients in Belginm. Chn Dmg Investig 2004 24(12) 719-29. 

The adverse reactions include slowing of gastrointestinal propulsion with the ensuing risk of constipation, which can be prevented with lactulose or lactitol. Opioid treatment can also cause nausea and sometimes vomiting. There is also a dependence problem and a risk of respiratory depression. The latter may be a practical problem in anaesthetic practice or in overdose, but rarely in the case of treatment with slowly increased oral doses. The nausea is... 

Constipation bulk-forming laxatives by increasing faecal mass tend to soften stools and relieve constipation, and have value in a range of symptomatic problems associated with anal fissure, haemorrhoids, and with ileostomy and colostomy dysfunction. Faecal softeners, lactulose and macrogols (polyethylene glycol) retain fluid in the bowel. Stimulant laxatives, such as the anthraquinone, senna, and bisacodyl, increase motility and can cause colic verdoses can cause diarrhea and electrolyte depletion. Chronic treatment for constipation is seldom needed, but may be in children with a tendency to faecal impaction, specialist advice should be sought. 

PO031 Passmore, A. P., K. Wilson-Davies, C. Stoker, and M. E. Scott. Chronic constipation in long stay elderly patients a comparison of lactulose and a senna-fiber combination. Brit Med J 1993 307(6907) 769-771. 

These agents may be used for the treatment of acute constipation or the prevention of chronic constipation. Magnesium oxide (milk of magnesia) is a commonly used osmotic laxative. It should not be used for prolonged periods in patients with renal insufficiency due to risk of hypermagnesemia. Sorbitol and lactulose are nonabsorbable sugars that can be used to prevent or... 

Discuss the benefits of senna (as above). He could try starting with one tablet to minimise the adverse effects. If he accepts this suggestion counsel him to take the tablets before bed (as they take 8-10 hours to work). If he is reluctant to try senna explain to him that lactulose is often insufficient alone in treating opioid-induced constipation, and may take 48 hours to work. 

Two women aged 88 and 82 taking lactulose for constipation, developed life-threatening dilatation of the bowel (16). Both underwent surgery. One had cancer of the bowel and an uneventful postoperative recovery. No mechanical abnormalities were found in the second patient but she died in respiratory insufficiency after aspiration. 

Pneumatosis intestinalis and pneumoperitoneum have been reported in a 57-year-old cirrhotic man with colonic inertia who had been taking oral lactulose 30 ml tds (38). Because of constipation the dose of lactulose had been gradually increased to 60 ml qds together with lactulose enemas. Both conditions resolved 3 days after oral lactulose was withdrawn. 

Dettmar PW, Sykes J. A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Curr Med Res Opin 1998 14(4) 227-33. 

Attar A, Lemann M, Ferguson A, Halphen M, Boutron MC, Flourie B, Alix E, Salmeron M, Guillemot F, Chaussade S, Menard AM, Moreau J, Naudin G, Barthet M. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999 44(2) 226-30. 

Urganci N, Akyildiz B, Polat TB. A comparative study the efficacy of liquid paraffin and lactulose in management of chronic functional constipation. Pediatr Int 2005 47(1) 15-19. 

Constipation is common when vinca alkaloids cause an autonomic neuropathy. Laxatives such as lactulose or polyethylene glycol-containing solutions can prevent... 

A major complication of constipation in the elderly is fecal impaction, a potentially serious condition that can result from ignoring impulses to defecate. Impaction is the buildup of fecal mass that becomes too large to expel. Increasing dietary fiber is part of the management program for chronic constipation of the elderly. Addition of bran (6-20 g/day) increases fecal weight and increases the frequency of defecation. When wheat bran is not effective, the laxative lactulose is recommended. Lactulose is a disaccharide composed of galactose and fructose connected by a p(l 4) bond. This compound is absorbed poorly in the small intestine because of the absence of enzymes that catalyze its hydrolysis. 

A 72-year-old man has started taking lactulose for chronic constipation not relieved by stool softeners. He takes 30 mL tid and over the past couple of days he has had two or three loose bowel movements a day. Which of the following would be the appropriate next step A. Discontinue the lactulose as it is not indicated for chronic use. 

Case Conclusion RE was given lactulose to help her constipation, and after three doses she had a bowel movement. Due to her elevated bilirubin, RE s vinaistine do was lowered by 50%. Her finger numbness was slightly better. Her neutrophils remained low until day 23. A repeat bone marrow biopsy perfom d after recovery demonstrated remission of her ALL. 

It may be noted that simple alkaline-catalyzed isomerization of glucose to fructose is possible, but gives rise to serious lactic acid and coloured by-product formation. Alkaline catalysis, however, is still applied for the conversion of lactose to lactulose, used in treatment of constipation and PSE. The reason is that no enzyme has been found that is able to isomerize the glucose unit of lactose into a fructose moiety. As a consequence, a low conversion is applied or borate is used as a protecting group. In the latter case extra separation and recycle steps are required. 

The patient s constipation could be caused by dihydrocodeine in the co-dydramol tablets constipation is a common side-effect of opiate analgesics. You could suggest that she try taking paracetamol alone, to see if that cured the constipation. If it did but did not control the arthritic pain sufficiently, you could suggest that she stays on co-dydramol and asks her general practitioner to prescribe a laxative - lactulose may be appropriate - for the constipation. 

Lactulose is a hyperosmotic agent, which produces increased osmotic pressure within colon and acidifies its contents, resulting in increased stool water content and stool softening. It causes migration of ammonia from blood into colon, where it is converted to ammonium ion and expelled through laxative action. It is indicated in the treatment of constipation and prevention and treatment of portal-systemic encephalopathy, including stages of hepatic precoma and coma. 

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