What is a good bowel cleanout regimen for a 13-year-old with moderate stool on a Kidney, Ureter, and Bladder (KUB) scan?

Bowel Cleanout Regimen for a 13-Year-Old with Moderate Stool on KUB

Polyethylene glycol (PEG) 3350 at a dose of 1.5 g/kg/day for 1-2 days is the recommended bowel cleanout regimen for a 13-year-old with moderate stool burden on KUB. 1, 2

First-Line Treatment Options

• PEG 3350 is the most effective and safe option for bowel cleanout in pediatric patients, with a recommended dose of 1.5 g/kg/day (not to exceed 100g/day) 1, 2
• A one-day PEG 3350 regimen has been shown to be effective in 93% of pediatric patients undergoing bowel preparation 2
• For moderate stool burden, treatment should continue for 1-2 days until clear liquid stool is produced 1
• PEG 3350 works by drawing water into the intestinal lumen, softening stool and promoting evacuation without significant electrolyte disturbances 3

Administration Protocol

• Mix PEG 3350 powder in 8 ounces of clear liquid (water, juice, sports drink) per 17g of powder 4
• Divide the total daily dose into 2-4 administrations throughout the day to improve tolerability 1
• Have the patient drink plenty of clear fluids throughout the cleanout process to maintain hydration 5
• Continue until bowel movements are watery and clear of solid stool 2

Adjunctive Measures

• Consider adding bisacodyl 10-15 mg daily (oral or rectal) if response to PEG alone is inadequate 5
• For patients with significant stool burden, a combination approach may be more effective:
  • Morning dose: PEG 3350 at 1 g/kg
  • Evening dose: PEG 3350 at 0.5 g/kg plus bisacodyl 10 mg 5
• Clear liquid diet during the cleanout period will enhance effectiveness 5

Alternative Options

• Senna (sennosides) can be used as an alternative stimulant laxative at age-appropriate dosing:
  • For 12+ years: 2-3 teaspoons (10-15 mL) once daily, maximum 3 teaspoons twice daily 6, 7
• Magnesium citrate (4-8 oz) can be considered if PEG is not tolerated, but monitor for electrolyte disturbances 5

Monitoring and Follow-Up

• Assess for adequate response, defined as production of watery stool without solid material 5
• Monitor for signs of dehydration or electrolyte imbalances, especially if using high doses of PEG or magnesium-based laxatives 5
• If cleanout is incomplete after 2 days of therapy, consider:
  • Adding a stimulant laxative if not already included
  • Increasing the PEG dose (up to 1.5 g/kg/day)
  • Administering a saline enema to clear the distal colon 5

Special Considerations

• Avoid sodium phosphate preparations in pediatric patients due to risk of electrolyte abnormalities and potential renal injury 5
• For patients with history of poor response to standard cleanout regimens, consider a more intensive approach with longer duration of therapy 5
• If the patient has signs of impaction, consider adding glycerin suppositories or mineral oil retention enemas 5

PEG 3350 has demonstrated superior efficacy and safety compared to other laxatives for pediatric bowel cleanout, with excellent tolerability and minimal side effects when properly administered 1, 3, 2.