Whole bowel irrigation

From WikEM
Jump to: navigation, search

Indications[1]

  • Sustained or delayed-release formulations
  • Agents with potential for bezoar formation
  • Iron and other heavy metals
  • Paint chips containing Lead
  • Lithium overdose (extended-release tablets)
  • Drugs carried by body packers
  • LIMPS = Lithium, Iron, Metals, Packers/stuffer, Sustained release drugs (BB, CCB)
  • Be mindful that the addition of PEG to activated charcoal significantly decreases AC's adsorptive capacity
    • likely competes with xenobiotic for adsorption by AC

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.