A 36-year-old man is brought to the emergency department by his girlfriend because of increasing confusion for the past 6 hours. He drinks large amounts of alcohol daily and occasionally uses illicit drugs. He is lethargic and oriented only to person. Physical examination shows jaundice, hepatomegaly, and scattered petechiae over the trunk and back. Neurologic examination shows normal, reactive pupils and a flapping tremor when the wrists are extended. A drug with which of the following mechanism of action would be most appropriate for this patient's condition?

Question

Quizplus · Accepted Answer

Eductional Objective: Hepatic encephalopathy is caused by the accumulation of toxic metabolites (predominantly ammonia) in the systemic circulation due to liver failure. Lactulose administered orally (or rectally) is converted to lactic acid in the intestine, leading to acidification in the gut and promoting the conversion of ammonia (NH3) to ammonium (NH4+). Ammonium is not absorbed in the intestine and is instead excreted in feces, reducing the overall systemic load of ammonia.

A 36-Year-Old Man Is Brought to the Emergency Department by His