Lactulose/rifaximin

Abstract

Lactulose/rifaximinLack of drug effect: case report A 42-year-old man exhibited a lack of drug effect during treatment with lactulose and rifaximin for multifactorial encephalopathy. The man with history of alcohol induced liver cirrhosis (MELD-Na 13, Child Pugh-A), presented to emergency room due to one week history of worsening abdominal pain and distension. He used to live alone and reported loosing his job recently due to the pandemic that lead to an increase in his daily alcohol intake for the past month (increased to 12 beers daily from previous 6 beers). He last consumed alcohol 2 days prior to the presentation. Test showed negative result for COVID-19 infection. Further tests showed severe hyponatremia, acute kidney injury and tense ascites with worsening liver cirrhosis (MELD-Na 32, Child Pugh-C). Hyponatraemia resolved with unspecified appropriate treatment, and kidney function improved with midodrine, octreotide and albumin. Additionally, he received lactulose and rifaximin [routes and dosages not stated] for multifactorial encephalopathy (alcohol withdrawal, ICU delirium and hepatic encephalopathy); however, no improvement was noted and his hospitalisation was prolonged. Subsequently, he was shifted to ICU due to suspected aspiration versus hospital acquired pneumonia. He was then moved to comfort care and died on day 22 of to hospitalisation [immediate cause of death not stated].