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Drug of the Day: Lactulose. Lactulose is a unique medication that works in the colon, not the bloodstream. It isn’t digested in the small intestine, so it reaches the colon unchanged, where gut bacteria convert it into acids. These acids lower the pH of the colon, which helps trap ammonia in a non-absorbable form. This makes lactulose a first-line treatment for hepatic encephalopathy by helping remove toxic ammonia from the body. It also works as an osmotic laxative by drawing water into the col
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