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Information about Whole Bowel Irrigation

Whole bowel irrigation (WBI) is a medical process involving the rapid administration of large volumes of an osmotically balanced polyethylene glycol solution (GoLYTELY®, CoLyte®), either orally or via a nasogastric tube, to flush out the entire gastrointestinal tract.

History

Whole bowel irrigation was originally developed to cleanse the large bowel before surgery or colonoscopy.[1] Initially a solution of sodium chloride, potassium chloride, and sodium bicarbonate was used but this electrolyte solution was shown to be absorbed by the body, sometimes leading to complications. To solve this problem a specialized irrigation fluid was developed consisting mainly of an iso-osmolar solution of polyethylene glycol.[2] With the polyethylene glycol solution there is negligible fluid or electrolyte absorption and several studies have shown the overall safety of the procedure. Whole bowel irrigation was also suggested as a possible treatment for toxic ingestions.[2] WBI has the effect of mechanically flushing the ingested poison out of the gastrointestinal tract before it can be absorbed into the body. A study provided evidence that whole bowel irrigation is an effective and safe gastrointestinal decontamination procedure for acute poisoning.[3]

Technique

Whole bowel irrigation is undertaken either by having the patient drink the solution or a nasogastric tube is inserted and the solution is delivered down the tube into the stomach. The solution is administered at a rate of 500 mL/h in children 9 months to 6 years, 1000 mL/h in children 6 to 12 years, and 1500 to 2000 mL/h in adolescents and adults.[4] The patient is usually seated on a toilet and the procedure continues until the rectal effluent is clear. The entire procedure usually takes 4 to 6 hours.[5] Often patients vomit (especially if ipecac was given prior to the procedure or following ingestion of a drug that produces vomiting such as aspirin or theophylline), indicating that the rate of infusion may need to be slowed or an antiemetic such as metoclopramide given.

Indications

Whole bowel irrigation is indicated prior to surgery, colonoscopy, or a barium enema to cleanse the bowel. Whole bowel irrigation is not used routinely in poisoning situations. It is usually reserved for patients who have ingested toxic doses of medications not absorbed by activated charcoal (such as iron and lithium), potentially toxic ingestions of sustained-release or enteric-coated drugs, or in the situation of packaged drug ingestion (body packing/stuffing).[4]

Contraindications

Major gastrointestinal dysfunction precludes the use of whole bowel irrigation. WBI is specifically contraindicated in the presence of ileus, significant gastrointestinal hemorrhage, hemodynamic instability, uncontrollable intractable vomiting, bowel obstruction, bowel perforation, and in patients with a decreased level of consciousness with a compromised unprotected airway.[4]

Complications

Minor complications include nausea, vomiting, abdominal cramps, and bloating.[6] Patients with altered mental status or a compromised and unprotected airway are at risk for pulmonary aspiration.[4]

References

1. ^ Hewitt J, Reeve J, Rigby J, Cox A (1973). "Whole-gut irrigation in preparation for large-bowel surgery". Lancet 2 (7825): 337-40. PMID 4124525. 
2. ^ Davis G, Santa Ana C, Morawski S, Fordtran J (1980). "Development of a lavage solution associated with minimal water and electrolyte absorption or secretion". Gastroenterology 78 (5 Pt 1): 991-5. PMID 7380204. 
3. ^ Tenenbein M, Cohen S, Sitar D (1987). "Whole bowel irrigation as a decontamination procedure after acute drug overdose". Arch Intern Med 147 (5): 905-7. PMID 3579442. 
4. ^ (2004) "Position paper: whole bowel irrigation". J Toxicol Clin Toxicol 42 (6): 843-54. PMID 15533024. 
5. ^ Tenenbein M. "Whole bowel irrigation as a gastrointestinal decontamination procedure after acute poisoning". Med Toxicol Adverse Drug Exp 3 (2): 77-84. PMID 3287090. 
6. ^ Ernstoff J, Howard D, Marshall J, Jumshyd A, McCullough A (1983). "A randomized blinded clinical trial of a rapid colonic lavage solution (Golytely) compared with standard preparation for colonoscopy and barium enema". Gastroenterology 84 (6): 1512-16. PMID 6341159. 

See also

Polyethylene glycol (PEG) and polyethylene oxide (PEO) are polymers composed of repeating subunits of identical structure, called monomers, and are the most commercially important polyethers.
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Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube, NG tube) through the nose, past the throat, and down into the stomach.
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surgery (from the Greek χειρουργική meaning "hand work") is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment.
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Intervention:
Colonoscopy

ICD-10 code:
ICD-9 code: 45.23

Other codes: Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera
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For sodium in the diet, see salt.


Sodium chloride, also known as common salt, table salt, or halite, is a chemical compound with the formula NaCl.
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The chemical compound potassium chloride (KCl) is a metal halide composed of potassium and chlorine. In its pure state it is odorless. It has a white or colorless vitreous crystal, with a crystal structure that cleaves easily in three directions.
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Sodium bicarbonate is the chemical compound with the formula NaHCO3. Because it has long been known and is widely used, the salt has many other names including sodium hydrogencarbonate, sodium bicarb, baking soda, bread soda,
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An electrolyte is a substance containing free ions that behaves as an electrically conductive medium. Because they generally consist of ions in solution, electrolytes are also known as ionic solutions, but molten electrolytes and solid electrolytes are also possible.
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Polyethylene glycol (PEG) and polyethylene oxide (PEO) are polymers composed of repeating subunits of identical structure, called monomers, and are the most commercially important polyethers.
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poisons are substances that can cause damage, illness, or death to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism.
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Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube, NG tube) through the nose, past the throat, and down into the stomach.
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In anatomy, the stomach is a bean-shaped hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. The word stomach is derived from the Latin stomachus, which derives from the Greek word
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The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long.
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Emesis redirects here. For the genus of metalmark butterflies, see Emesis (butterfly). Heaving redirects here. For the up-and-down motion, see heave.

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Syrup of ipecac (derived from the dried rhizome and roots of the Ipecacuanha plant), is an emetic—a substance used to induce vomiting. It is used in cases of accidental poisoning, and is perhaps the best-known emetic.
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Aspirin®, or acetylsalicylic acid (IPA: /əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd/
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Theophylline, also known as dimethylxanthine, is a methylxanthine drug used in therapy for respiratory diseases such as COPD or asthma under a variety of brand names. Due to its numerous side effects, these drugs are now rarely used clinically.
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An anti-emetic is a drug that is effective against vomiting and nausea. Anti-emetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics and chemotherapy directed against cancer.
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Metoclopramide (INN) (IPA: [mɛtəˈkloprəmaɪd, -ˈklɒ-]) is a potent dopamine receptor antagonist used for its antiemetic and prokinetic properties.
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A lower gastrointestinal series, also called a barium enema, is a medical procedure used to examine and diagnose problems with the human colon (large intestine). X-ray pictures are taken while barium sulfate fills the colon via the rectum.
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In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine.
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Activated carbon, also called activated charcoal or activated coal, is a general term which covers carbon material mostly derived from charcoal. For all three variations of the name, "activated" is sometimes substituted by "active".
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3, 4, 6
(amphoteric oxide)
Electronegativity 1.83 (Pauling scale)
Ionization energies
(more) 1st: 762.5 kJmol−1
2nd: 1561.9 kJmol−1
3rd: 2957 kJmol−1

Atomic radius 140 pm
Atomic radius (calc.
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Lithium (IPA: /ˈlɪθiəm/) is a chemical element with the symbol Li and atomic number 3. It is a soft alkali metal with a silver-white color.
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mule or courier is someone who smuggles something with him or her (as opposed to sending by mail, etc.) across a national border, including smuggling into and out of an international plane, especially a small amount, transported for a smuggling organization.
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Ileus, formerly called iliac passion, refers to limited or absent intestinal passage.

Types

Mechanical ileus

Main article: Bowel obstruction

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Bleeding, technically known as hemorrhage (American English) or haemorrhage (British English) is the loss of blood from the circulatory system.[1] Bleeding can occur internally, where blood leaks from blood vessels inside the body or externally, either
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Nausea
Classifications and external resources

ICD-10 R 11.
ICD-9 787.0

Nausea (Latin: Nausea, Greek: Ναυτεία
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Emesis redirects here. For the genus of metalmark butterflies, see Emesis (butterfly). Heaving redirects here. For the up-and-down motion, see heave.

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Bloating
Classifications and external resources

ICD-10 R14
ICD-9 787.3

Bloating is any abnormal general swelling, or increase in diameter of the abdominal area.
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