From the Guidelines
Whole bowel irrigation with polyethylene glycol (PEG) solution is primarily used to prepare the colon for urgent colonoscopic therapy in cases of acute lower gastrointestinal bleeding, by rapidly purging the colon with 4-6 liters of PEG solution over 3-4 hours. The purpose of this procedure is to cleanse the bowel, allowing for better visualization during the colonoscopy, and it may be particularly useful when the bleeding point is not yet known 1. The use of PEG solution for bowel irrigation is supported by its isotonic nature, which minimizes fluid and electrolyte shifts, making it a preferred option for patients with certain medical conditions, such as renal insufficiency, congestive heart failure, and advanced liver disease 1. Key points to consider when using PEG solution for whole bowel irrigation include:
- Administering the solution at a rate of 1-2 liters per hour in adults, or 25-40 mL/kg/hour in children, until rectal effluent is clear or for approximately 4-6 hours
- Using a nasogastric tube or oral consumption for administration
- Monitoring patients for signs of aspiration, especially if mental status is altered
- Being aware of contraindications, such as bowel obstruction, perforation, ileus, hemodynamic instability, and compromised airway protection. It is essential to note that the effectiveness of PEG solution for whole bowel irrigation can depend on various factors, including the timing of administration and the specific clinical context 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Purpose of Whole Bowel Irrigation with Polyethylene Glycol (PEG) Solution
The purpose of whole bowel irrigation with polyethylene glycol (PEG) solution is to:
- Remove ingested toxins from the gastrointestinal tract before absorption, limiting systemic toxicity 2, 3, 4
- Reduce the absorption of a poison or drug in cases of overdose 2, 3
- Empty the gastrointestinal tract of ingested substances, particularly in cases where the substance cannot be absorbed by activated charcoal and has passed the pylorus 3
- Expel tablets or packets from the rectal effluent in cases of poisoning 4
Indications for Whole Bowel Irrigation
Whole bowel irrigation is indicated in:
- Selected cases of potentially lethal overdose where the toxic substance cannot be absorbed by charcoal and has passed the pylorus 3
- Patients who have ingested modified-release preparations 4
- Patients who have ingested pharmaceuticals not adsorbed by activated charcoal 4
- Removal of packages in "body packers" 4
Efficacy and Safety
Whole bowel irrigation has been shown to be effective in reducing the absorption of certain substances, such as ampicillin 2 and iron 5. However, its use is not without challenges and adverse effects, and its routine use in poisoned patients is not recommended 4. The solution can also decrease the adsorption of certain substances, such as theophylline, to activated charcoal 6.