II. Indications: Toxic Ingestion
- Toxins with poor binding with Activated Charcoal
- Heavy Metal Ingestion
-
Body Stuffers and Body Packers
- Expulsion of drug packets
- Sustained release products, enteric coated products, or pharmacobezoars
- Oral Hypoglycemic medications
- Atypical Antipsychotic Overdose
III. Contraindications
- Unprotected airway
- Significant Gastrointestinal Hemorrhage
- Bowel perforation
- Bowel Obstruction
- Intractable Vomiting
- Hemodynamic instability
- Ingestion of Corrosive Chemical
IV. Protocol
- Consider performing Endotracheal Intubation prior to procedure if concerns regarding aspiration risk
- Polyethlene Glycol Electrolyte Solution (PEG-ES, e.g. Golytely) administered orally or via Nasogastric Tube
- Most patients require Nasogastric Tube in order to maintain the needed PEG-ES volume intake
- May use Activated Charcoal first or combined with PEG-ES (consult poison control)
- Patient sits on toilet
- Insert rectal tube for intubated or debilitated patients
- Measures that decrease patient adverse effects
- Warm PEG-ES may prevent Hypothermia
- Slowly increase rate to target rate during first hour
- Dose (administered until rectal effluent is clear - typically 4-6 hours)
- Children 9 months to 5 years: 500 ml/hour
- Children 6 to 12 years: 1000 ml/hour
- Teens and Adults: 1500 to 2000 ml/hour
V. Adverse Effects
- Common Adverse Effects (10% of patients)
- Nausea and Vomiting
- Abdominal cramping
- Abdominal Bloating
- Serious Adverse Effects (rare)
- Aspiration Pneumonitis or Pneumonia
- Hypersensitivity to Polyethlene Glycol Electrolyte Solution (PEG-ES)
- Hypothermia (from large volume of cool fluid)
VI. References
- Warrington and Paravati (2018) Crit Dec Emerg Med 32(6): 11
- (2004) J Toxicol Clin Toxicol 42(6): 843-54 [PubMed]