Whole bowel irrigation: Difference between revisions
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==Indications<ref>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.</ref>== | ==Indications<ref>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.</ref>== | ||
*'''''LIMPS''' = '''L'''ithium, '''I'''ron, '''M'''etals, '''P'''ackers/stuffer, '''S'''ustained 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 | |||
*'''''LIMPS''' = '''L'''ithium, '''I'''ron, '''M'''etals, '''P'''ackers/stuffer, '''S'''ustained release drugs ( | *Additional considerations: | ||
*Be mindful that the addition of PEG to activated charcoal significantly decreases | **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== | ==Contraindications== | ||
Revision as of 01:17, 14 May 2019
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
- ↑ 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.