A retrospective review of whole bowel irrigation in pediatric patients

Jean C Y Lo, Cathy Ubaldo, F Lee Cantrell
Clinical Toxicology 2012, 50 (5): 414-7

BACKGROUND: Traditionally whole bowel irrigation (WBI) has been advocated for ingestions involving substances not bound with activated charcoal as well as extended release and enteric coated medications. Other than isolated case reports, little exists in the literature regarding the use of WBI in poisoned pediatric patients. The purpose of this study is to better understand the use of WBI in pediatric patients.

METHOD: A retrospective chart review of California Poison Control System electronic database for human poisoning cases between the years 2000 and 2010 was performed.

RESULTS: A total of 176 cases were identified. The most common age of poisoned patients that received WBI was 2 years. There were more pediatric patients who received WBI between 2000 and 2005 then between 2006 and 2010. The top three substances in which WBI was used were calcium channel blockers, iron, and antidepressants. There were 72 cases involving sustained release and delayed release substances. The top five sustained release/delayed release substances were nifedipine, bupropion, verapamil, diltiazem, and felodipine. Adverse drug reactions were noted in 17 patients, vomiting in 16 patients and abdominal pain in one patient. In 36 cases, abdominal radiographs were performed. Sixteen were positive, and in four cases, repeat abdominal radiographs demonstrated a decrease in opacities. Twelve patients had documented pills in their effluent.

CONCLUSION: Transient adverse drug reactions, vomiting and abdominal pain, were associated with WBI. Polyethylene glycol plus electrolyte lavage solution (PEG-ELS) was more frequently administered through the nasogastric tube. Patients who underwent WBI through nasogastric tube received higher doses of PEG-ELS.

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