Whole Bowel Irrigation

Aka: Whole Bowel Irrigation

advertisement

II. Indications: Toxic Ingestion

  1. Toxins with poor binding with Activated Charcoal
  2. Heavy Metal Ingestion (large acute ingestions)
    1. Iron Ingestion
    2. Lithium Toxicity
  3. Body Stuffers and Body Packers
    1. Expulsion of drug packets
  4. Sustained release products, enteric coated products, or pharmacobezoars
    1. Oral Hypoglycemic medications
    2. Atypical Antipsychotic Overdose
    3. Large Potassium ingestions

III. Contraindications

  1. Unprotected airway
  2. Significant Gastrointestinal Hemorrhage
  3. Bowel perforation
  4. Bowel Obstruction
  5. Bowel ileus
  6. Intractable Vomiting
  7. Hemodynamic instability
  8. Ingestion of Corrosive Chemical

IV. Protocol

  1. Consider performing Endotracheal Intubation prior to bowel irrigation (prevent aspiration)
    1. Patient's head of bed to 45 degrees
  2. Abdominal XRay must confirm proper nasogastric (or orogastric) tube placement
    1. Early abdominal xray also estimate radiopaque contents, e.g. gatrointestinal iron
  3. Administer Activated Charcoal first or combined with PEG-ES (consult poison control)
  4. Polyethlene Glycol Electrolyte Solution (PEG-ES, e.g. Golytely) administered orally or via Nasogastric Tube
    1. Most patients require Nasogastric Tube in order to maintain the needed PEG-ES volume intake
    2. Consider using a feeding pump to administer Golytely and administer 500 ml every 15 min (2L/h)
  5. Patient sits on toilet
    1. Insert rectal tube for intubated or debilitated patients
  6. Measures that decrease patient adverse effects
    1. Warm PEG-ES may prevent Hypothermia
    2. Slowly increase rate to target rate during first hour
  7. Dose (administered until rectal effluent is clear - typically 4 to 6 hours, up to 10 hours)
    1. Adults (and teens age>=13 years): 1500 to 2000 ml/hour
    2. Children (age <13 years): 25 ml/kg/h
      1. Children 9 months to 5 years: 500 ml/hour
      2. Children 6 to 12 years: 1000 ml/hour

V. Adverse Effects

  1. Common Adverse Effects (10% of patients)
    1. Nausea and Vomiting
    2. Abdominal cramping
    3. Abdominal Bloating
  2. Serious Adverse Effects (rare)
    1. Aspiration Pneumonitis or Pneumonia
    2. Hypersensitivity to Polyethlene Glycol Electrolyte Solution (PEG-ES)
    3. Hypothermia (from large volume of cool fluid)

VI. References

  1. Swaminathan and Weingart (2025) Gastric Decontamination, EM:Rap, 9/18/2025
  2. Warrington and Paravati (2018) Crit Dec Emerg Med 32(6): 11
  3. (2004) J Toxicol Clin Toxicol 42(6): 843-54 [PubMed]
  4. Vega (2024) Am Fam Physician 109(2): 143-53 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Whole Bowel Irrigation." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Topics in Pharmacology

advertisement