My father was diagnosed with end-stage liver disease, cirrhosis, and hepatic encephalopathy about 5 years ago. He was pretty stable until last Christmas, and his health has seriously declined since then. We are having a really hard time keeping his ammonia levels under control, despite following his liver doctor's orders to the letter. He is normally on 3/x daily of 30 m/l lactulose, and when his ammonia ticks up (as we can tell from increased cognitive impairment, decline of motor skills, etc.), we provide it to him every 2-3 hours until symptoms improve. Except that they often don't. He went back in the hospital yesterday for the 10th time this year, because his ammonia levels got so high that he couldn't talk, walk, swallow. We don't know what else to do to manage his condition. Any advice or similar experience would be appreciated.