Elevated Ammonia Levels

My son has 4th stage liver disease & is awaiting transplant, MELD score is 16.  He has recently begun having bouts of high ammonia levels-3 or 4 day good then 3 or 4 days bad.  He takes laculose, which he adjusts as needed, & another med in pill form.  Are there any other things that he can do to mitigate the ammonia besides meds & low protein diet?

[Thomas D Schiano, MD]

we use xifaxan as an adjunctive agent to lactulose so as to minimize the dose of lactulose which helps a great deal.  If xifaxan is not paid for by the insurance, then neomycin is a another choice.  he must avoid dehydration, high blood sugars, etc.