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 technique can be 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 are mostly theoretical and will be refined as more extensive data become available. The role of whole bowel irrigation currently remains limited.
Current methods of gastrointestinal decontamination (i.e., emesis, gastric lavage, and 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.2 This reduces absorption of the drug or toxin throughout the gastrointestinal tract. The 3500 Da molecular weight polyethylene glycol solution is specifically designed to prevent electrolyte and fluid shifts.
Whole bowel irrigation may be indicated for acute ingestions where severe or potentially fatal toxicity is anticipated (Table 61-1). 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 safely utilized to decrease bioavailability of ingested iron, lithium, and heavy metals.3–7 Whole bowel irrigation has been proposed to be effective in flushing the gastrointestinal tract free of toxicant before absorption can be affected by sustained-release preparations.8 Whole bowel irrigation may speed gastrointestinal transit of ingested packets or vials of illicit drugs ingested by a “body packer.”9 Recently, the role of whole bowel irrigation in the “body stuffing syndrome” has recently been questioned.10 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.
Table 61-1 Conditions in Which Whole Bowel Irrigation Can Be Considered ||Download (.pdf)
Table 61-1 Conditions in Which Whole Bowel Irrigation Can Be Considered
|1. Acute, life-threatening, or serious ingestion and hemodynamically stable|
2. Any of the following:
Delayed or enteric-coated preparation
Ingested packets of illicit drug
Toxin or toxicant poorly adsorbed by activated charcoal
There are few contraindications to performing whole bowel irrigation (Table 61-2). It should not be used in the setting of a patient with a potentially compromised or unprotected airway. Whole bowel irrigation could result in pulmonary aspiration.11,12 Significant vomiting will hinder the ability to perform whole bowel irrigation. ...