Whole bowel irrigation: Difference between revisions

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==Background==
==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 toxicity|Iron]]
 
**[[heavy metal toxicity|Heavy metals]]
 
**Toxic ingestions of sustained- or delayed-release formulations
==Relative Indications==
**Drugs carried by body packers
#Sustained or delayed-release formulations
*Additional considerations:
#Agents with potential for bezoar formation
**Agents that cause [[bezoar]] or concretion formation
#Iron and other heavy metals
**Paint chips containing [[lead]]
#Paint chips containing lead
*Be mindful that the addition of PEG to activated charcoal significantly decreases activated charcoal's adsorptive capacity
#Lithium
#Drugs carried by body packers


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


==Procedure==
==Procedure==
*Give polyethylene glycol via NGT or PO (if pt tolerates) until rectal effluent is clear
*Give polyethylene glycol via NGT or PO (if tolerates) until rectal effluent is clear
**Adult: 1.5-2 L/hr
**Adult: 1.5-2 L/hr
**Peds 6-12yr: 1 L/hr
**Peds 6-12yr: 1 L/hr
**Peds <6yr: 0.5 L/hr
**Peds <6yr: 0.5 L/hr
*Give ondansetron or metoclopramide as needed for N/V
**Peds alt: 20-40 mL/kg/hr in young children
 
''Give [[ondansetron]] or [[metoclopramide]] as needed for [[nausea/vomiting]]''


==Complications==
==Complications==
#Bloating, cramping, rectal irritation (from frequent bowel movements)
*Bloating
*Cramping
*Rectal irritation (from frequent bowel movements)
 
==See Also==
*[[Gastric Lavage]]
*[[Activated charcoal]]
*[[Multidose Activated Charcoal (MDAC)]]


==Source==
==References==
*Tintinalli
<references/>


[[Category:Procedures]]
[[Category:Procedures]]
[[Category:Toxicology]]

Revision as of 15:59, 10 October 2019

Indications[1]

  • LIMPS = Lithium, Iron, Metals, Packers/stuffer, Sustained release drugs (especially beta-blockers, calcium channel blockers)
  • 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 ondansetron 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.