Which finding indicates a therapeutic response to lactulose?

A therapeutic response to lactulose is indicated by an increased level of consciousness. Lactulose is primarily used in the treatment of hepatic encephalopathy, a condition where liver dysfunction leads to the accumulation of toxins in the bloodstream, affecting brain function. By decreasing the absorption of ammonia in the intestines and promoting its excretion through the stool, lactulose helps to clear these toxins from the body. As the levels of ammonia decrease, the patient’s neurological status improves, leading to a heightened level of consciousness.

The other findings mentioned in the options do not directly relate to the therapeutic effects of lactulose. For instance, increased liver enzymes would indicate liver damage rather than improvement, while decreased urinary calcium and increased gastric pH do not have a direct connection to the intended outcomes of lactulose therapy. Thus, an increased level of consciousness serves as a clear indication that lactulose is effectively addressing the symptoms of liver dysfunction and improving the patient's overall condition.