Whole-bowel irrigation

Whole-bowel irrigation with polyethylene glycol-electrolyte lavage solution has become popular for colon cleansing before diagnostic procedures or colorectal operations. 

American Academy of Clinical Toxicology and European Association of Poisons Centers and Clinical Toxicologists. Position paper whole Bowel irrigation. J Toxicol Clin Toxicol 2004 42(6) 843-54. 

General supportive care should be provided. Aggressive gut decontamination should be carried out using repeated doses of activated charcoal and whole bowel irrigation. Propranolol or other blockers (eg, esmolol) are useful antidotes for B-mediated hypotension and tachycardia. Phenobarbital is preferred over phenytoin for convulsions most anticonvulsants are ineffective. Hemodialysis is indicated for serum concentrations greater than 100 mg/L and for intractable seizures in patients with lower levels. 

Internal Decontamination. The most recommended methods of internal decontamination Include gastric lavage, whole bowel irrigation and administration of activated charcoal. 

Treatment requires general supportive care as outlined earlier. Since most ingested calcium antagonists are in a sustained-release form, it may be possible to expel them before they are completely absorbed initiate whole bowel irrigation and oral activated charcoal as soon as possible, before calcium antagonist-induced ileus intervenes. Calcium, given intravenously in doses of 2-10 g, is a useful antidote for depressed cardiac contractility but less effective for nodal block or peripheral vascular collapse. 

Swanson-Biearman, B., Dean, B.S., Krenzelok, E.P. (1992). Failure of whole bowel irrigation to decontaminate the GI tract following massive jequirity bean ingestion [abst.]. Vet. Hum. Toxicol. 34 352-7. 

Previously popular, primary decontamination with gastric lavage, emetics, whole bowel irrigation and cathartics may not be effective in preventing or delaying enteric absorption of poisons [9-12]. In contrast, multiple-dose oral activated charcoal is an effective method of enteric decontamination for a wide variety of ingestions [13]. However, all enteric decontamination procedures are contraindicated in petroleum distillate and caustic ingestions. 

Position paper whole bowel irrigation. J Toxicol Clin Toxicol. 2004 42 843-854... 

Gastric lavage, whole bowel irrigation with polythene glycol... 

No specific treatment is available for toxalbumin exposure. Aggressive gastric decontamination such as whole bowel irrigation is recommended. It is unlikely... 

Treatment is based on the patient s clinical presentation. Basic and advanced life support measures should be performed as needed. Activated charcoal may be utilized to adsorb orally administered fentanyl, such as the ingestion of a fentanyl patch. Whole bowel irrigation should be considered to speed the... 

Supportive measures, including administration of blood products, parenteral fluid, and electrolytes, are recommended. Removal of the seeds from the gastrointestinal tract can be done with charcoal. Whole bowel irrigation may also be considered after a dose of charcoal for patients with voluminous ingestions. Alkalinization of the urine with sodium bicarbonate has been recommended for the prevention of hemoglobin precipitates in the renal tubules. 

The use of ipecac syrup, gastric lavage, and cathartics has fallen out of favor as routine therapies, whereas activated charcoal and whole-bowel irrigation are still useful for the gastric decontamination of appropriate patients. 

Polyethylene glycol electrolyte solutions, such as GoLytely and Colyte, are used routinely as whole-bowel irrigants prior to colonoscopy and bowel surgery. These solutions also can be used as a means to decontaminate the gastrointestinal tract of ingested toxins. " Large volumes of these osmotically balanced solutions... 

Some clinicians believe that whole-bowel irrigation should be used more routinely as a rapid means to evacuate the gastrointestinal tract. Others recognize that it does have a quick onset but point out that there is little proof that it makes a difference in patient outcome. 

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