Indications and Contraindications for Whole Bowel Irrigation (WBI)

 

Indications:

(1) overdose with sustained-release or enteric-coated preparations, especially if it has been > 2 hours since the drug ingestion

(2) substantial overdose with iron preparation

(3) ingested packets of illicit drugs

(4) drugs or chemicals not absorbed by activated charcoal

(5) heavy metal poisoning (arsenic, thallium, mercury)

(6) miniature disc batteries

 

Absolute contraindications:

(1) bowel obstruction

(2) bowel perforation

(3) ileus

(4) clinically significant gastrointestinal hemorrhage

(5) hemodynamic instability

(6) compromised or unprotected airway

(7) uncontrollable, intractable vomiting

 

Relative contraindications:

(1) debilitated patient

(2) presence of comorbid conditions that could worsen with the WBI

(3) very young age (the dosage table does not list for < 9 months of age)

 

The fluid used for irrigation is a mixture of high molecular weight polyethylene glycol (PEG-3350) and isosmolar electrolyte solution containing sodium sulfate (PEG-ELS). Commercial preparations are GoLytely and Colyte.

 

Technique:

(1) The fluid is administered by a nasogastric tube. It should be administered at room temperature; chilling the fluid can result in hypothermia.

(2) Dosage varies with age:

Age	Fluid Delivery Rate
9 months to 6 years	500 mL per hour
6 to 12 years	1,000 mL per hour
adolescent	1,500 - 2,000 mL per hour
adult	1,500 - 2,000 mL per hour

 

(3) The patient should have a commode readily available.

(4) It is not administered with activated charcoal since it may reduce the effectiveness of the charcoal, since it absorbs the polyethylene glycol.

(5) The administration is continued until:

(5a) the fluid passed per rectum is clear and

(5b) there is no evidence of residual toxin in the intestines