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Glutaminase Lactose permease L-lactate permease Beta- galactosidase Lactulose Ammonium D-Glucose Methane L-Lactic acid H+ NH3 Lactulose Lactulose H2O H2O L-Lactic acid Methane H+ NH3 H2O D-Galactose H+ Hydroxide H2O NH3 Hydroxide L-Lactic acid Methane H+ Lactate L-Glutamine H2O L-Glutamic acid Magnesium Sodium Excretion Glycolysis (Escherichia coli (strain K12)) Protein Synthesis (Escherichia coli (strain K12)) Colonic bacterial cell 1. Lactulose is metabolized to volatile acids, mainly lactic acid, but acetic acid and formic acid can also be formed. Gases such as methane and hydrogen are also formed Acidic pH 2. Lactic acid in the intestine increases the pH and osmotic pressure, thus stimulating peristalsis 4. Metabolism of lactulose increases intraluminal gas which contribute to colon distension and peristalsis 3. Due to the high osmotic pressure in the colon lumen, water is drawn in. This further contributes to colon distension, softening of the stool and peristalsis 5. The acidic environment leads to the conversion of ammonia to ammonium. Ammonium can not cross cell membranes, and therefore is excreted in faeces 7. Ammonia is used as a nitrogen source in protein synthesis Urease-producing bacteria 8. The acidic pH destroys urease-producing bacteria involved in the production of ammonia, reducing intestinal production of ammonia 6. Colonic ammonia can be taken up and utilized by bacteria Intestinal epithelial cell 9. Lactulose can also decrease glutaminase activity, preventing the production of ammonia
GLS lacY lldP lacZ Lactulose Ammonium D-Glucose Methane L-Lactic acid Hydrogen Ammonia Lactulose Lactulose Water Water L-Lactic acid Methane Hydrogen Ammonia Water D-Galactose Hydrogen Ion Hydroxide Water Ammonia Hydroxide L-Lactic acid Methane Hydrogen Lactate L-Glutamine Water L-Glutamic acid Excretion Glycolysis (Escherichia coli (strain K12)) Protein Synthesis (Escherichia coli (strain K12))