Case: An unusual ICU referral
Dosing: Targeting the amount of electrolyte-free water loss
Osmotic laxatives: Lactulose
Basic physiology of osmotic laxatives
Dosing of lactulose
Monitoring osmotic diarrhea
Efficacy of lactulose to increase serum sodium
Safety of lactulose
Use of lactulose in specific situations
Urea & mannitol
- Patients with cirrhosis or heart failure often have mild, subacute or chronic hyponatremia which may be difficult to treat (e.g. hypertonic saline is generally avoided because it will cause volume overload).
- Vaptans are one option for treating hypervolemic hyponatremia. However, they are expensive, carry a risk sodium over-correction, and conivaptan is contraindicated in liver disease.
- Urea may be a good option to facilitate excretion of water in the urine, but it is not available in the USA.
- Lactulose is an osmotic laxative, which promotes loss of water in the stool. This may be an inexpensive and safe approach to gently correct hyponatremia.
- Hyponatremia I: Emergent treatment of hyponatremia or elevated ICP with bicarb ampules
- Hyponatremia II: Taking control of severe hyponatremia with DDAVP