Whole-bowel irrigation should not be used routinely in poisoned patients.
gastric decontamination
overdose
poisoning
whole-bowel irrigation
Journal
British journal of clinical pharmacology
ISSN: 1365-2125
Titre abrégé: Br J Clin Pharmacol
Pays: England
ID NLM: 7503323
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
received:
30
03
2023
accepted:
11
04
2023
medline:
21
7
2023
pubmed:
19
4
2023
entrez:
18
4
2023
Statut:
ppublish
Résumé
Whole-bowel irrigation is a method of gastric decontamination in the poisoned patient involving administration of large volumes of osmotically balanced polyethylene glycol-electrolyte solution to empty the gastrointestinal tract of ingested toxins before absorption, limiting systemic toxicity. While this approach may seem intuitive, and observational studies confirm it can lead to expulsion of tablets or packets in the rectal effluent, there is a lack of evidence correlating this with improved patient outcomes. Administration of whole-bowel irrigation is also challenging to the inexperienced physician and associated with adverse effects, which may be serious. Recommendations for whole-bowel irrigation are therefore limited to patients who have ingested modified-release preparations, those who have ingested pharmaceuticals not adsorbed by activated charcoal and for the removal of packages in "body packers". Until more robust evidence is available from high-quality prospective studies demonstrating efficacy, the use of whole-bowel irrigation should not be used routinely in poisoned patients.
Substances chimiques
Poisons
0
Charcoal
16291-96-6
Pharmaceutical Preparations
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2362-2364Informations de copyright
© 2023 The Author. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.
Références
Henry JA, Hoffman JR. Continuing controversy on gut decontamination. Lancet. 1998;352(9126):420-421. doi:10.1016/S0140-6736(05)79183-2
Greene S, Harris C, Singer J. Gastric decontamination of the poisoned patient. Pediatr Emerg Care. 2008;24(3):176-189. doi:10.1097/PEC.0b013e318166a092
Tominack R. Gastrointestinal decontamination: maybe we're both right (commentary). J Toxicol Clin Toxicol. 2000;38(7):691-692. doi:10.1081/CLT-100102380
Bailey B. Gastrointestinal decontamination triangle. Clin Toxicol (Phila). 2005;43(1):59-60.
Höjer J, Troutman WG, Hoppu K, et al. Position paper update: Ipecac syrup for gastrointestinal decontamination. Clin Toxicol (Phila). 2013;51(3):134-139. doi:10.3109/15563650.2013.770153
Benson BE, Hoppu K, Troutman WG, et al. Position paper update: gastric lavage for gastrointestinal decontamination. Clin Toxicol (Phila). 2013;51(3):140-146. doi:10.3109/15563650.2013.770154
Chyka PA, Seger D, Krenzelok EP, Vale JA, American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. Position paper: Single dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61-87. doi:10.1081/CLT-51867
Tenenbein M. Whole bowel irrigation as a gastrointestinal decontamination procedure after acute poisoning. Med Toxicol Adverse Drug Exp. 1988;3(2):77-84. doi:10.1007/BF03259934
American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. Position paper: Whole bowel irrigation. J Toxicol Clin Toxicol. 1997;35(7):753-762. doi:10.3109/15563659709162571
American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. Position paper: Whole bowel irrigation. J Toxicol Clin Toxicol. 2004;42(6):843-854. doi:10.1081/CLT-200035932
Thanacoody R, Caravati EM, Troutman B, et al. Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila). 2015;53(1):5-12. doi:10.3109/15563650.2014.989326
Tenenbein M. The role of whole bowel irrigation in the treatment of toxic ingestions. Br J Clin Pharmacol. 2023;1-3. doi:10.1111/bcp.15652
Tenebein M, Cohen S, Sitar DS. Whole bowel irrigation as a decontamination procedure after acute overdose. Arch Intern Med. 1987;147(5):905-907. doi:10.1001/archinte.1987.00370050101017
Kirshenbaum LA, Mathews SC, Sitar DS, Tenebein M. Whole bowel irrigation versus activated charcoal in sorbitol for the ingestion of modified-release pharmaceuticals. Clin Pharmacol Ther. 1989;46(3):264-271. doi:10.1038/clpt.1989.137
Smith SW, Ling LJ, Halstenson CE. Whole bowel irrigation as a treatment for acute lithium overdose. Ann Emerg Med. 1991;20(5):536-539. doi:10.1016/S0196-0644(05)81610-5
Lapatto-Reiniluoto O, Kivisto KT, Neuvonen PJ. Activated charcoal alone and followed by whole bowel irrigation in preventing the absorption of sustained release drugs. Clin Phamacol Ther. 2001;70(3):255-260. doi:10.1067/mcp.2001.118184
Kumar VV, Oscarsson S, Friberg LE, Isbister GK, Hackett LP, Duffull SB. The effect of decontamination procedures on the pharmacokinetics of venlafaxine in overdose. Clin Pharmacol Ther. 2009;86(4):403-410. doi:10.1038/clpt.2009.114
Kumar VV, Isbister GK, Duffull SB. The effect of decontamination procedures on the pharmacodynamics of venlafaxine in overdose. Br J Clin Pharmcol. 2011;72(1):125-132. doi:10.1111/j.1365-2125.2011.03934.x
Deguigne M, Legeay M, Scholastique AS, Chauveau P, Descatha A. Whole-bowel irrigation in cases of poisoning: a retrospective multicentre study of feasibility, tolerability, and effectiveness. Aust Crit Care. 2022;S1036-7314. doi:10.1016/j.aucc.2022.03.007
Vodovar D, Megarbane B. Assessing effectiveness of whole bowel irrigation in poisoning: a laudable effort but still insufficient evidence. Aust Crit Care. 2022. doi:10.1016/j.aucc.2022.10.003
Bryant SM, Weiselberg R, Metz J, Wahl M, Aks SE. Should no bowel irrigation be a higher priority than whole bowel irrigation in the treatment of sustained release product ingestions? Clin Toxicol (Phila). 2008;46:266 (abstract).
Bretaudeau Deguigne M, Hamel JF, Boels D, Harry P. Lithium poisoning: the value of early digestive tract decontamination. Clin Toxicol (Phila). 2013;51(4):243-248. doi:10.3109/15563650.2013.782409
Lo JCY, Ubaldo C, Cantrell FL. A retrospective review of whole bowel irrigation in pediatric patients. Clin Toxicol (Phila). 2012;50(5):414-417. doi:10.3109/15563650.2012.679277
Beckley I, Ansari NAA, Khwaja HA, Mohnsen Y. Clinical management of cocaine body packers: the Hillingdon experience. Can J Surg. 2009;52:417-421.
Traub SJ, Hoffman RS, Nelson LS. Body packing-the internal concealment of illicit drugs. N Engl J Med. 2003;349(26):2519-2526. doi:10.1056/NEJMra022719
Bryant SM, Weiselberg R, Metz J, Wahl M, Aks SE. Treating body stuffers with whole bowel irrigation: should we flush the procedure? Clin Toxicol (Phila). 2008;46:621 (abstract).
Farmer JW, Chan SB. Whole bowel irrigation for contraband body packers. J Clin Gastroenterol. 2003;37(2):147-150. doi:10.1097/00004836-200308000-00011
Cumpston KL, Aks SE, Sigg T, Pallasch E. Whole bowel irrigation and the haemodynamically unstable calcium channel blocker overdose: primum non nocere. J Emerg Med. 2010;38(2):171-174. doi:10.1016/j.jemermed.2007.11.100
de Graaf P, Slagt C, de Graaf JL, Loffeld RJ. Fatal aspiration of polyethylene glycol solution. Neth J Med. 2006;64(6):196-198.
Metheny NA, Meert KL. Administering polyethylene glycol electrolyte solution via a nasogastric tube: pulmonary complications. Am J Crit Care. 2017;26:e11-e17.
Nissen T, Wynn R. The clinical case report: a review of its merits and limitations. BMC Res Notes. 2014;7(1):264. doi:10.1186/1756-0500-7-264