Do you use lactulose in acute liver failure, particularly in patients on continuous renal replacement therapy (CRRT) for ammonia or toxin clearance?

Generally lactulose should be avoided in the situation given limited benefit as well a tendency for ileus in ALF and potential for lactulose to cause bowel distention.

Generally taught that HE caused by true ALF is not treatable with lactulose or rifaximin, and they have no role in the management. In ALF, the liver is necrotic (not cirrhotic) and has lost all function. In this setting, patients just need to be stabilized with high quality ICU care, and await liver...