Completion of whole bowel irrigation in emergency department overdose patients

Abstract

Study objectives: Whole bowel irrigation (WBI) for toxicologic patients has a number of specific indications. The utility of this gastric decontamination method is time and resource consuming. The objective of this study is to assess the ability to complete the WBI process when it is recommended by a poison control center for a toxicologic indication in patients presenting to an emergency department (ED). Methods: This was a prospective, institutional review board–approved, observational study. The inclusion criteria were overdose poison control center patients who met an American Academy of Clinical Toxicology WBI position paper indication for the use of WBI. On study enrollment, WBI instructions were explained by telephone and faxed (each case offered this) to health care providers. Data were collected at enrollment and 4-hour intervals. Data collected included patient demographics, overdose information, and WBI information. The main study endpoint was the successful completion of WBI as defined by a clear rectal effluent. Results: Eighteen patients were enrolled; 78% were men, and the mean age was 30.8 years. WBI indications were substance poorly adsorbed by charcoal, 38%; enteric-coated or sustained-release drug, 33%; foreign body, 33%; and a massive overdose, 0%. Ninety-five percent of cases involved intentional ingestions. Of the 18 patients enrolled, 4 (22%) completed the WBI. The mean time to clear rectal effluent was 32.2 hours. Only 1 case completed WBI in less than 15 hours. Conclusion: WBI is an uncommonly used and labor-intensive procedure recommended in specific toxicologic patients. When recommended for use by a poison control center in the ED, the majority of patients do not complete therapy adequately. Further studies need to address the reasons for these findings.