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HWN Suggests

Whole-bowel irrigation should not be used routinely in poisoned patients

While this approach may seem intuitive, and observational studies confirm it can lead to expulsion of tablets or packets in the rectal effluent, there is a lack of evidence correlating this with improved patient outcomes. Administration of whole-bowel irrigation is also challenging to the inexperienced physician and associated with adverse effects, which may be serious. Recommendations for whole-bowel irrigation are therefore limited to patients who have ingested modified-release preparations, those who have ingested pharmaceuticals not adsorbed by activated charcoal and for the removal of packages in “body packers”. Until more robust evidence is available from high-quality prospective studies…

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Articles of Interest

Management of body packers in the emergency department

Whole bowel irrigation with a polyethylene glycol-electrolyte lavage solution can flush down the drug packets towards the anal opening to effect safe and gentle evacuation. During the procedure, the lavage solution is administered at the rate of two liters per hour until the effluent is clear and no drug-filled packets are detectable in a follow-up contrast study.

ToxCard: GI Decon

Whole bowel irrigation (WBI) refers to the administration of osmotically balanced polyethylene glycol electrolyte solution to induce liquid stool and mechanically flush pills, tablets, or drug packets from the GI tract.

Whole bowel irrigation for gastrointestinal decontamination of overdose patients

It has the potential to reduce drug absorption by decontaminating the entire gastrointestinal tract by expelling intraluminal contents. However, this procedure can be poorly tolerated, cause discomfort, and in some cases give rise to complications.

Whole Bowel Irrigation Position Paper Update... Well, Not Really

WBI can facilitate removal of select toxicants from the gastrointestinal tract in some patients, but there is no convincing evidence from clinical studies that it improves the outcome of poisoned patients... Potentially toxic ingestions of sustained-release or enteric-coated drugs, Substantial ingestions of iron, lithium, or potassium. Removal of ingested packets of illicit drugs in "body packers".

Whole Bowel Irrigation- Indications, Contraindications, Procedure, and Complications

Infusion of polyethylene glycol electrolyte solution decreases the contact time with the gastrointestinal mucosa. This reduces the absorption of the drug or toxin throughout the gastrointestinal tract, and also the solution is specifically designed to prevent electrolyte and fluid shifts.

Whole-Bowel Irrigation and Other Intestinal Evacuants

The most effective process of evacuating the GI tract in poisoned patients is referred to as whole-bowel irrigation (WBI). Whole-bowel irrigation is typically accomplished using polyethylene glycol with a balanced electrolyte lavage solution (PEG-ELS).

“Gotta Go Right Now”: Use of Whole Bowel Irrigation in the Treatment of Lithium Toxicity

The pneumonic “LIMPS” is a helpful reminder for some indications for use of whole bowel irrigation (lithium, iron, metals, packers/stuffers, sustained release drugs). The procedure entails placement of a nasogastric (NG) tube and initiation of polyethylene glycol (PEG) through the NG until clear rectal effluent is achieved. In adults, it is recommended to instill 1.5-2 L of PEG per hour (1 L/hr for pediatrics age 6-12, 0.5 L/hr for pediatrics <6 years).