Which finding indicates lactulose is effectively reducing ammonia in hepatic encephalopathy?

• A. Decrease albumin levels
• B. Decrease Fetor Hepaticus
• C. Patient is stuporous
• D. Decreased ammonia blood level

Answer: (D)

Lactulose works by acidifying the gut and trapping ammonia as ammonium, which is then excreted in the stool, reducing the amount of ammonia entering the bloodstream. The most direct and best indicator that this is working is a decreased ammonia level in the blood, because it shows the toxin load is actually being reduced. As ammonia drops, mental status typically improves. While a reduction in fetor hepaticus can occur with treatment, it’s not a precise measure of ammonia reduction. Albumin levels reflect liver synthetic function and aren’t directly changed by lactulose, and a stuporous state signifies worsening encephalopathy rather than improvement.