Whole bowel irrigation: Difference between revisions
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*'''''LIMPS''' = '''L'''ithium, '''I'''ron, '''M'''etals, '''P'''ackers/stuffer, '''S'''ustained release drugs (especially beta-blockers, calcium channel blockers) | *'''''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) | **[[Lithium overdose]] (extended-release tablets) | ||
**Iron | **[[iron toxicity|Iron]] | ||
**Heavy metals | **[[heavy metal toxicity|Heavy metals]] | ||
**Toxic ingestions of sustained- or delayed-release formulations | **Toxic ingestions of sustained- or delayed-release formulations | ||
**Drugs carried by body packers | **Drugs carried by body packers | ||
*Additional considerations: | *Additional considerations: | ||
**Agents that cause bezoar or concretion formation | **Agents that cause [[bezoar]] or concretion formation | ||
**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 | *Be mindful that the addition of PEG to activated charcoal significantly decreases activated charcoal's adsorptive capacity | ||
| Line 24: | Line 24: | ||
**Peds alt: 20-40 mL/kg/hr in young children | **Peds alt: 20-40 mL/kg/hr in young children | ||
''Give [[ | ''Give [[ondansetron]] or [[metoclopramide]] as needed for [[nausea/vomiting]]'' | ||
==Complications== | ==Complications== | ||
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)
- Lithium overdose (extended-release tablets)
- Iron
- Heavy metals
- Toxic ingestions of sustained- or delayed-release formulations
- Drugs carried by body packers
- Additional considerations:
- 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
- ↑ 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.