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Whole bowel irrigation is the infusion of polyethylene glycol electrolyte lavage solution into the stomach at flow rates higher than are otherwise commonly used. This is a relatively new technique used to decontaminate the gastrointestinal tract after an acute toxic ingestion or overdose. Most of the literature supporting its use is in the form of case reports or case series.1 While available reports are compelling, the indications for whole bowel irrigation will likely evolve as more extensive data becomes available. To date, the demonstrated role of whole bowel irrigation remains limited.

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Current methods of gastrointestinal decontamination (emesis, gastric lavage, activated charcoal administration) focus primarily on decontaminating the stomach. Absorption of most toxicants occurs principally in the proximal small bowel. Sustained- or delayed-release preparations continue to liberate drug during intestinal transit that is then available for absorption throughout the bowel. Infusion of polyethylene glycol electrolyte lavage solution decreases the enteric transit time, attenuating the contact time of a toxicant with the gastrointestinal mucosa. This reduces absorption of the drug or toxin throughout the gastrointestinal tract. The 3500 dalton molecular weight polyethylene glycol solution is specifically designed to prevent electrolyte and fluid shifts.

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Whole bowel irrigation is indicated for acute ingestions where severe or potentially fatal toxicity is anticipated (Table 50-1). Other decontamination methods, such as activated charcoal, should be employed if they are known to be effective rather than whole bowel irrigation. Whole bowel irrigation may be indicated in situations where activated charcoal is known to be ineffective. Whole bowel irrigation has been effectively utilized to decrease bioavailability of ingested iron, lithium, and heavy metals.2–6 Whole bowel irrigation is effective at flushing the gastrointestinal tract free of toxicant before absorption can be affected by sustained-release preparations.7 Whole bowel irrigation may speed gastrointestinal transit of ingested packets or vials of illicit drugs ingested by a “body packer” or “body stuffer.”8 While the indications are limited, additional settings may be envisioned where whole bowel irrigation might be useful. Unfortunately, there is not yet data to support broader indications.

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Table 50-1. Conditions in Which Whole Bowel Irrigation Should Be Considered
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There are few contraindications to performing whole bowel irrigation (Table 50-2). The infusion of polyethylene glycol into a patient with a potentially compromised or unprotected airway could result in pulmonary aspiration.1 Significant vomiting may hinder the ability to perform whole bowel irrigation until the vomiting can be brought under control. Theoretical contraindications include abnormal upper airway or upper gastrointestinal anatomy (anomaly, stricture, fresh interposition graft). Ingestion of toxic substances that markedly slow gastrointestinal motility (e.g., ...

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