Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Neurocritical Care
Published in: Neurocritical Care 2/2018

01-04-2018 | Neurocritical care through history

Lactulose: A Simple Sugar in a Complex Encephalopathy

Author: Eelco F. M. Wijdicks

Published in: Neurocritical Care | Issue 2/2018

Login to get access

Abstract

Hepatic encephalopathy is a common encephalopathy and one of the very few that are treatable. Lactulose has remained a standard pharmaceutical intervention and is listed as one of the World Health Organization’s Essential Medicines. The discovery of lactulose, the acid dialysis proof of concept, and the role of Bircher are not well known. This historical vignette reviews the gradual understanding of the complex liver–brain connection, the effective treatment of hepatic stupor with lactulose, and the immediate relevance of lactulose to the practice of consultative neurocritical care.
Literature
1.
Frerichs FT. A clinical treatise on the diseases of the liver, vol. I. New York: William Wood & Co.; 1879.
2.
Adams RD, Foley JM. The neurological disorder associated with liver disease. Res Publ Assoc Res Nerv Ment Dis. 1953;32:198–237.
3.
Sherlock S, Summerskill WH, White LP, Phear EA. Portal-systemic encephalopathy; neurological complications of liver disease. Lancet. 1954;267:454–7.
4.
Parsons-Smith BG, Summerskill WH, Dawson AM, Sherlock S. The electroencephalograph in liver disease. Lancet. 1957;273:867–71.CrossRef
5.
Record CO, Chase RA, Hughes RD, Murray-Lyon IA, Williams R. Glycerol therapy for cerebral oedema complicating fulminant hepatic failure. Br Med J. 1975;2:540.CrossRef
6.
Plum F, Posner JB, editors. The diagnosis of stupor and coma. 3rd ed. Philadelpha: F. A. Davis Co.; 1980.
7.
Canalese J, Gimson AE, Davis C, Mellon PJ, Davis M, Williams R. Controlled trial of dexamethasone and mannitol for the cerebral oedema of fulminant hepatic failure. Gut. 1982;23:625–9.CrossRef
8.
Phear EA, Sherlock S, Summerskill WH. Blood-ammonium levels in liver disease and hepatic coma. Lancet. 1955;268:836–40.CrossRef
9.
Bircher J, Muller J, Guggenheim P, Haemmerli UP. Treatment of chronic portal-systemic encephalopathy with lactulose. Lancet. 1966;1:890–2.
10.
Elkington SG, Floch MH, Conn HO. Lactulose in the treatment of chronic portal-systemic encephalopathy. A double-blind clinical trial. N Engl J Med. 1969;281:408–12.CrossRef
11.
Haemmerli UP, Bircher J. Wrong idea, good results (the lactulose story). N Engl J Med. 1969;281:441–2.CrossRef
12.
Hoffmann K, Mossel DA, Korus W, Van De Kamer JH. Studies on the mechanism of action of lactulose (beta-galactoside action of lactulose (beta-galactosido-fructose) in the intestine. Klin Wochenschr. 1964;42:126–30.CrossRef
13.
Ingelfinger FJ. Discussion of paper by Hoffmann, K., et al. (Klin. Wchnschr. 42:126–130, 1964). In: Beeson PB, editor. Year Book of Medicine 1964–1965. Chicago: Year Book Medical Publishers; 1964–1965. pp. 591–592.
14.
Guggenheim P, Regli F, Hafen G, Haemmerli UP. Electroencephalographic studies in chronic liver disease before and after morphine administration: attempt at an objectivation of the diagnosis “Precoma” and “Hepatic Coma”. Dtsch Med Wochenschr. 1964;89:748–55.CrossRef
15.
Als-Nielsen B, Gluud LL, Gluud C. Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials. BMJ. 2004;328:1046.CrossRef
16.
Atterbury CE, Maddrey WC, Conn HO. Neomycin-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy. A controlled, double-blind clinical trial. Am J Dig Dis. 1978;23:398–406.CrossRef
17.
Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. Gastroenterology. 1977;72:573–83.CrossRef
18.
Simmons F, Goldstein H, Boyle JD. A controlled clinical trial of lactulose in hepatic encephalopathy. Gastroenterology. 1970;59:827–32.CrossRef
19.
Rahimi RS, Rockey DC. Hepatic encephalopathy: pharmacological therapies targeting ammonia. Semin Liver Dis. 2016;36:48–55.CrossRef
Metadata
Title
Lactulose: A Simple Sugar in a Complex Encephalopathy
Author
Eelco F. M. Wijdicks
Publication date
01-04-2018
Publisher
Springer New York
Published in
Neurocritical Care / Issue 2/2018
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-017-0494-4

Other articles of this Issue 2/2018

Neurocritical Care 2/2018 Go to the issue

Letter to the editor

Reply to “Comments on the Cerebral Edema After CPR: A Therapeutic Target Following Cardiac Arrest?”

A day in the life of a fellow

Neurogenic Stress Cardiomyopathy Precipitated by Acute Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

Original Article

Early Brain Injury Associated with Systemic Inflammation After Subarachnoid Hemorrhage

Letter to the Editor

Response to “Letter to the Editor” by R. Dhar

Letter to the Editor

Letter to the Editor

Translational Research

Comparison of Quantitative Characteristics of Early Post-resuscitation EEG Between Asphyxial and Ventricular Fibrillation Cardiac Arrest in Rats