Lactulose question

When my guy was first sick...he was BAD, BAD sick. HE very bad. Not expected to live. The lactulose worked like a charm. 1 20 ml does and he would have 3 or 4 BMs by early afternoon and was clear as a bell. Recently he was hospitalized for pneumonia and had a sudden severe spike in ammonia and rapid HE. They gave him a ton of lactulose and he had a bm about 1 per hour round the clock. They sent him home on 3 doses at 20 ml. But it does not get him enough BMs only one or two and he has times of confusion. Does lactulose stop working as effectively? The reason I ask is they also gave him gabapentin the day before he left the hospital. Researching it I see it can cause confusion itself, plus constipation. I also think it does nothing for his pain so I am considering stopping it. I am just worried that he is not going enough. Yesterday I gave 20 ml every 4 hours for 4 doses and only got 2 BMs. Docs are gone for the weekend so I can't call anyone.

Absolutely not stopping the lactulose. I know it is the heavy hitter. When he was clear for a while today I talked to him and we are stopping the gaba. He takes oxy less than once a week. His hips are collapsed to bone on bone and cause him significant pain. But he is trying to "gut it out" until his liver stabilizes enough to have his hip replacement surgery. He is on fluid restrictions.... 2L a day. His BMs are pretty loose the problem is no matter how much lactulose I give him I can't get three a day. Today I am giving 25 ml every 3 hours... its 4:30 in the pm and still nothing.... I have been giving it since 8 this morning. No gaba since the am.

I was someway have Hep b and am on liver transplant list. , I was being hospitalized 4 days at a time every third week. I was so bad dropping dishes and having trouble walking and every time fire Dept had to get me strapped down and carry me out of house and I don’t remember anything that happened every time. Was drinking a lot of dairy for protein and water it cause my sodium level so low too, was hospital for over week almosted move to ICU cause was so Low but slow came up with a sodium liquid drip. I met this one doctor that told me he has seen others like me and said need to get you on Xifaxan pill and take three a day this medicine has taken me off lactolos and never been hospitalized now for over a year. I use lactolos as back up. But when on pill the high. Ammonia level comes in slowly and once can’t ready like guide on TV or for me my hands start shaking I use one dose of lactolos and takes it away within 30-1hr. I had been dealing with just using lactolos for 3yrs till someone tried to get me on xifaxan. Medicaid will fight you cause not approved but doc can appeal that and saves me from going to hospital ever month which is huge savings to them. So if not taking Xifaxan get him on it. It was my lifesaver of much better life and don’t have to sit on toilet all time like you have with lactolos.