Whole bowel irrigation as a gastrointestinal decontamination procedure after acute poisoning.

Abstract

Assuming a stable or stabilised patient, preventing the absorption of ingested toxins becomes a primary objective in the treatment of acute overdose. Traditional interventions aimed at achieving this end include ipecac-induced emesis, large bore orogastric lavage and activated charcoal administration (Cupit & Temple 1984; Easom & Lovejoy 1979). Whether any of these procedures benefits the patient remains unknown. Induced emesis and gastric lavage have especially been questioned (Comstock et al. 1981; Corby et al. 1968; Fane et al. 1971; Neuvonen et al. 1983; Tenenbein 1985a; Vale et al. 1986) and the literature seems to favour activated charcoal administration without a gastric emptying procedure (Chin 1972; Curtis et al. 1984; Fane et al. 1971; Kulig et al. 1985; Tenenbein et al. 1987a). However, the most common practice is to use one of the gastric emptying procedures, followed by activated charcoal. Apart from the concerns about their effectiveness, situations arise where all 3 of these interventions can be expected to be of limited benefit to the poisoned patient. These include the ingestion of a very large amount of a toxic substance (e.g. many times the lethal dose) , late presentation after the overdose, ingestion of delayed release pharmaceuticals and ingestion of substances not adsorbed by activated charcoal (particularly iron). In these situations whole bowel irrigation with polyethylene glycol electrolyte lavage solution offers promise as a method of treatment. The purpose of this article is to review relevant data and experience regarding this technique.