Whole bowel irrigation (WBI) is a medical process involving the rapid administration of large volumes of an osmotically balanced macrogol solution (GoLYTELY, CoLyte), either orally or via a nasogastric tube, to flush out the entire gastrointestinal tract.
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 macrogol. [2] With the macrogol 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 in 1987 provided evidence that whole bowel irrigation is an effective and safe gastrointestinal decontamination procedure for acute poisoning. [3] Its common administration for toxic ingestions has been largely replaced with that of activated charcoal.
Whole bowel irrigation is sometimes used prior to colonoscopy, bowel surgery, other abdominal/pelvic surgery, or a barium enema examination, to cleanse the intestines, enhancing visibility of the intestines' inner surfaces, preventing complications from occurring as a result of spillage of bowel contents into the abdominal cavity, and potentially providing other benefits depending on the type of procedure being performed.
Whole bowel irrigation is also used in certain 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]
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. When administered to adolescents and adults as preparation for surgery, colonoscopy, or another procedure, the solution is usually taken orally, unless oral administration is contraindicated. Orally, the solution may be taken in a wide variety of settings, and is usually taken at a rate of 240 mL (8 oz.) every 10 to 20 minutes. Nasogastrically, the solution is generally 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] When used to cleanse the bowels for a procedure, the total volume of solution prescribed is usually 2 to 4 liters, which is often taken at home by the patient.
When used as treatment for poisoning, the procedure is usually performed in a healthcare facility, and normally continues until the rectal effluent is clear. [5]
Vomiting is a common side effect of the macrogol solutions used for WBI, which may hinder the effectiveness of the procedure for any indication. In cases of poisoning, the presence of vomiting prior to the procedure is not uncommon. It may be the result of administration of ipecac prior to the procedure, and/or a symptom of the poisoning itself. Overdoses of such drugs as aspirin and theophylline are likely to result in vomiting. Whenever vomiting occurs before or during WBI, the rate of the procedure may need to be slowed, alternatives considered, or an antiemetic such as metoclopramide administered.
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]
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]
Several other laxatives are available for cleansing of the bowels prior to colonoscopy, surgery, or other procedures. Studies have shown some of these to be comparable to macrogol solutions in terms of effectiveness and better tolerated by patients due to the lower volume of laxative which must be ingested. Enemas are another option.
Alternatives to WBI in cases of poisoning may include gastric lavage, activated charcoal, syrup of ipecac, mechanically induced vomiting, administration of alternate laxatives, antidotes and/or symptomatic treatment for systemic poisoning, and watchful waiting. However, every poisoning situation is unique and appropriate treatment options are evaluated on a case-by-case basis.
In biology, poisons are substances that can cause death, injury or harm to organs, tissues, cells, and DNA usually by chemical reactions or other activity on the molecular scale, when an organism is exposed to a sufficient quantity.
An enema, also known as a clyster, is an injection of fluid into the lower bowel by way of the rectum. Also, the word enema can refer to the liquid so injected, as well as to a device for administering such an injection.
Laxatives, purgatives, or aperients are substances that loosen stools and increase bowel movements. They are used to treat and prevent constipation.
Iron poisoning typically occurs from ingestion of excess iron that results in acute toxicity. Mild symptoms which occur within hours include vomiting, diarrhea, abdominal pain, and drowsiness. In more severe cases, symptoms can include tachypnea, low blood pressure, seizures, or coma. If left untreated, iron poisoning can lead to multi-organ failure resulting in permanent organ damage or death.
Colonoscopy or coloscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It can provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected colorectal cancer lesions.
Syrup of ipecac, commonly referred to as ipecac, is a drug that was once widely used as an expectorant and a rapid-acting emetic. It is obtained from the dried rhizome and roots of the ipecacuanha plant, from which it derives its name.
Ileus is a disruption of the normal propulsive ability of the intestine. It can be caused by lack of peristalsis or by mechanical obstruction. The word 'ileus' is from Ancient Greek eileós. The term 'subileus' refers to a partial obstruction.
Virtual colonoscopy is the use of CT scanning or magnetic resonance imaging (MRI) to produce two- and three-dimensional images of the colon, from the lowest part, the rectum, to the lower end of the small intestine, and to display the images on an electronic display device. The procedure is used to screen for colon cancer and polyps, and may detect diverticulosis. A virtual colonoscopy can provide 3D reconstructed endoluminal views of the bowel. VC provides a secondary benefit of revealing diseases or abnormalities outside the colon.
Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach. Since its first recorded use in early 19th century, it has become one of the most routine means of eliminating poisons from the stomach. Such devices are normally used on a person who has ingested a poison or overdosed on a drug such as ethanol. They may also be used before surgery, to clear the contents of the digestive tract before it is opened.
Gastrointestinal perforation, also known as ruptured bowel, is a hole in the wall of part of the gastrointestinal tract. The gastrointestinal tract includes the esophagus, stomach, small intestine, and large intestine. Symptoms include severe abdominal pain and tenderness. When the hole is in the stomach or early part of the small intestine the onset of pain is typically sudden while with a hole in the large intestine onset may be more gradual. The pain is usually constant in nature. Sepsis, with an increased heart rate, increased breathing rate, fever, and confusion may occur.
Lower gastrointestinal bleeding, commonly abbreviated LGIB, is any form of gastrointestinal bleeding in the lower gastrointestinal tract. LGIB is a common reason for seeking medical attention at a hospital's emergency department. LGIB accounts for 30–40% of all gastrointestinal bleeding and is less common than upper gastrointestinal bleeding (UGIB). It is estimated that UGIB accounts for 100–200 per 100,000 cases versus 20–27 per 100,000 cases for LGIB. Approximately 85% of lower gastrointestinal bleeding involves the colon, 10% are from bleeds that are actually upper gastrointestinal bleeds, and 3–5% involve the small intestines.
Phosphate nephropathy or nephrocalcinosis is an adverse renal condition that arises with a formation of phosphate crystals within the kidney's tubules. This renal insufficiency is associated with the use of oral sodium phosphate (OSP) such as C.B. Fleet's Phospho soda and Salix's Visocol, for bowel cleansing prior to a colonoscopy.
Bisacodyl (INN) is an organic compound that is used as a stimulant laxative drug. It works directly on the colon to produce a bowel movement. It is typically prescribed for relief of episodic and chronic constipation and for the management of neurogenic bowel dysfunction, as well as part of bowel preparation before medical examinations, such as for a colonoscopy.
Sodium picosulfate is a contact stimulant laxative used as a treatment for constipation or to prepare the large bowel before colonoscopy or surgery. It is sold under the trade names Sodipic Picofast, Laxoberal, Laxoberon, Purg-Odan, Picolax, Guttalax, Namilax, Pico-Salax, PicoPrep, and Prepopik, among others.
Macrogol, also known as polyethylene glycol (PEG), is used as a medication to treat constipation in children and adults. It is also used to empty the bowels before a colonoscopy. It is taken by mouth. Benefits usually occur within three days. Generally it is only recommended for up to two weeks.
Colon cleansing, also known as colon therapy, or colon hydrotherapy, or a colonic, or colonic irrigation encompasses a number of alternative medical therapies claimed to remove unspecified toxins from the colon and intestinal tract by removing supposed accumulations of feces. Colon cleansing in this context should not be confused with an enema which introduces fluid into the colon, often under mainstream medical supervision, for a limited number of purposes including severe constipation and medical imaging.
Paracetamol poisoning, also known as acetaminophen poisoning, is caused by excessive use of the medication paracetamol (acetaminophen). Most people have few or non-specific symptoms in the first 24 hours following overdose. These include feeling tired, abdominal pain, or nausea. This is typically followed by a couple of days without any symptoms, after which yellowish skin, blood clotting problems, and confusion occurs as a result of liver failure. Additional complications may include kidney failure, pancreatitis, low blood sugar, and lactic acidosis. If death does not occur, people tend to recover fully over a couple of weeks. Without treatment, death from toxicity occurs 4 to 18 days later.
Tricyclic antidepressant overdose is poisoning caused by excessive medication of the tricyclic antidepressant (TCA) type. Symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. If symptoms have not occurred within six hours of exposure they are unlikely to occur.
Salicylate poisoning, also known as aspirin poisoning, is the acute or chronic poisoning with a salicylate such as aspirin. The classic symptoms are ringing in the ears, nausea, abdominal pain, and a fast breathing rate. Early on, these may be subtle, while larger doses may result in fever. Complications can include swelling of the brain or lungs, seizures, low blood sugar, or cardiac arrest.
Lithium toxicity, also known as lithium overdose, is the condition of having too much lithium. Symptoms may include a tremor, increased reflexes, trouble walking, kidney problems, and an altered level of consciousness. Some symptoms may last for a year after levels return to normal. Complications may include serotonin syndrome.
| Fields | |
|---|---|
| Concepts | |
| Treatments | |
| Incidents | |
| Related topics | |
