{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:16:12Z","timestamp":1777853772239,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To review ICU patients with elevated ammonia without a clear hepatic etiology, to compare outcomes between those who received lactulose and those who did not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Medical, surgical, and subspecialty intensive care units at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina between December 2012 and August 2016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>Adults with ammonia levels above 50 \u03bcmol\/L, excluding those with known chronic liver disease, inborn error of metabolism, active use of valproic acid, total bilirubin \u2265 2 \u03bcmol\/L, or alanine aminotransferase \u2265 100 units\/L.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>Comparison in ICU length of stay (LOS), hospital LOS, in-hospital mortality, and mortality at 30 and 90 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results:<\/jats:title>\n                    <jats:p>Criteria for inclusion were met in 103 cases. Mean ammonia level was 75 \u03bcmol\/L, with undetermined etiology in the majority of subjects. Lactulose was given in 48 cases (46.6%), with a median of 9.5 doses given. There were no significant differences in outcomes between the lactulose and non-lactulose groups. Among subjects with multiple data points, lactulose did not have a dose-dependent effect on ammonia level, and was not associated with faster ammonia normalization compared to non-lactulose. When analyzed separately, patients with moderate hyperammonemia (60-99 \u03bcmol\/L) who received lactulose had longer hospital and ICU length of stay compared to non-lactulose (417.8 hours vs. 208.4 hours, P = 0.003, and 229.2 hours vs. 104.7 hours, P = 0.025; respectively), though confounders were present.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Routine use of lactulose to treat mild to moderate hyperammonemia in this patient population was not associated with improved outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666211023004","type":"journal-article","created":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T05:32:32Z","timestamp":1623130352000},"page":"698-706","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Use of Lactulose to Treat Hyperammonemia in ICU Patients Without Chronic Liver Disease or Significant Hepatocellular Injury"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5474-1571","authenticated-orcid":false,"given":"Nathan S.","family":"Cutler","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Naval Medical Center Portsmouth, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett W.","family":"Sadowski","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Naval Medical Center Portsmouth, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Drew A.","family":"MacGregor","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Section on Critical Care Medicine, Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston-Salem, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,6,8]]},"reference":[{"key":"bibr1-08850666211023004","doi-asserted-by":"publisher","DOI":"10.1007\/s10545-012-9546-2"},{"key":"bibr2-08850666211023004","doi-asserted-by":"publisher","DOI":"10.1007\/s11011-016-9938-3"},{"key":"bibr3-08850666211023004","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01477-8"},{"issue":"3","key":"bibr4-08850666211023004","first-page":"160","volume":"24","author":"Qureshi MO","year":"2014","journal-title":"J Coll Physicians Surg 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