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Tip for Hospice Nurses: Patients with end-stage cirrhosis are at risk for developing hepatic encephalopathy from the buildup of ammonia. This usually presents as a progressive decline in LOC. The doctor will usually order Lactulose either prophylactically (30ml BID) or as a treatment dose (30ml QID) after symptoms have presented. Lactulose is very sweet and many pts do not like the taste - if the pt is alert, mixing it with water or juice may help. If the pt is lethargic, it can be administered
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