Whole bowel irrigation

(Redirected from Whole Bowel Irrigation)

Indications[1]

  • LIMPS = Lithium, Iron, Metals, Packers/stuffer, Sustained release drugs (especially beta-blockers, calcium channel blockers)
    • Lithium overdose (extended-release tablets)
    • Iron
    • Heavy metals
    • Toxic ingestions of sustained- or delayed-release formulations
    • Drugs carried by body packers
  • Additional considerations:
    • Agents that cause bezoar or concretion formation
    • Paint chips containing lead
  • Be mindful that the addition of PEG to activated charcoal significantly decreases activated charcoal's adsorptive capacity

Contraindications

  • Preceding diarrhea
  • Ingestion of substances expected to result in significant diarrhea (except heavy metals)
  • Bowel obstruction (as evidenced by lack of bowel sounds)
  • avoid chilled solutions in neonates given risk for hypothermia

Procedure

  • Give polyethylene glycol via NGT or PO (if tolerates) until rectal effluent is clear
    • Adult: 1.5-2 L/hr
    • Peds 6-12yr: 1 L/hr
    • Peds <6yr: 0.5 L/hr
    • Peds alt: 20-40 mL/kg/hr in young children

Give ondansteron or metoclopramide as needed for nausea/vomiting

Complications

  • Bloating
  • Cramping
  • Rectal irritation (from frequent bowel movements)

See Also

References

  1. Thanacoody, R, et al. Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol. 2015; 53(1):5-12. doi: 10.3109/15563650.2014.989326.

Authors:

Ross Donaldson