From the Guidelines
For a patient with moderate fecal loading already on Peglyte twice daily, I recommend adding a stimulant laxative such as bisacodyl (5-10 mg orally daily) or considering an enema with sodium phosphate, saline, or tap water to help stimulate peristalsis and encourage a bowel movement. The patient is already on polyethylene glycol, which is an osmotic laxative, but the presence of moderate fecal loading suggests that the current dose may not be sufficient or that additional therapy is needed 1. Increasing the dose of polyethylene glycol could be considered, but adding a stimulant laxative may be more effective in promoting a bowel movement. It's also important to assess the patient's fluid intake and encourage them to drink at least 2-3 liters of fluid per day to help soften the stool.
Some key points to consider when managing this patient include:
- Assessing the cause and severity of constipation to rule out obstruction or other underlying conditions 1
- Considering the use of peripherally acting mu opioid receptor antagonists such as oral methylnaltrexone, naloxegol, or naldemedine if constipation is clearly related to opioid therapy 1
- Avoiding the use of rectal suppositories or enemas in patients with neutropenia or thrombocytopenia 1
- Limiting the use of oral laxatives or enemas that contain sodium phosphate to a maximum dose of once daily in patients at risk for renal dysfunction 1
Overall, the goal is to promote a bowel movement and prevent further fecal loading, while also considering the patient's underlying medical conditions and potential interactions with other medications. Adding a stimulant laxative or considering an enema are reasonable next steps in managing this patient's moderate fecal loading.
From the Research
Patient Already on Peglyte Twice Daily with Moderate Fecal Loading
- The patient is currently taking Peglyte (Polyethylene glycol) twice daily but still has moderate fecal loading, indicating that the current dosage may not be sufficient to achieve the desired outcome 2, 3.
- Studies have shown that increasing the dose of Polyethylene glycol can be effective in treating severe constipation and fecal impaction 2, 4, 5.
- One study found that a combined regimen of Polyethylene glycol and sodium picosulphate was effective in removing fecalomas in children with severe constipation and impaction 4, 5.
- Another study suggested that adding a stimulant laxative to Polyethylene glycol can improve disimpaction and long-term management of constipation in pediatric patients 5.
- The optimal dose of Polyethylene glycol to provide satisfactory relief of constipation within 24 hours has been found to be around 68g in a single dose 6.
Possible Next Steps
- Consider increasing the dose of Peglyte or adding a stimulant laxative to the current regimen, under medical supervision 4, 5.
- Monitor the patient's response to the adjusted treatment and adjust as needed to achieve the desired outcome 2, 3.
- Ensure that the patient is adequately hydrated and consider other factors that may be contributing to the constipation, such as diet and physical activity 3, 6.