Table of Contents
What is wilson disease?
Add lactulose if any of the following are present:
- Overt hepatic encephalopathy
- Altered sensorium
- Irritability, sleep reversal
- Asterixis
- Minimal / impending HE
- Poor school performance
- Behavioral change
- Subtle confusion
- Advanced decompensated liver disease
- High ammonia levels (if measured)
- Severe portal hypertension with prior HE
- Acute liver failure due to Wilson disease
👉 Dose (pediatrics):
- 0.5–1 mL/kg/dose orally
- Titrate to 2–3 soft stools/day
When lactulose is NOT needed
Do not add lactulose if the child has:
- Wilson disease with hepatitis only
- No encephalopathy
- Normal mental status
- Compensated chronic liver disease
Adding lactulose unnecessarily may cause:
- Diarrhea
- Electrolyte imbalance
- Poor compliance
What should be prioritized instead
For Wilson disease with hepatitis, focus on:
✅ Copper chelation
- D-penicillamine (with pyridoxine)
- OR Trientine
✅ Zinc therapy (as maintenance or adjunct)
✅ Supportive liver care
- Low-copper diet
- Salt restriction if ascites
- Diuretics if needed
- Fat-soluble vitamins if cholestasis
Exam-oriented takeaway (very important)
Lactulose is NOT a routine drug in Wilson disease.
It is used only for hepatic encephalopathy, not for hepatitis itself.