Position Paper: Whole Bowel Irrigation

@article{Toxicologists2004PositionPW,
  title={Position Paper: Whole Bowel Irrigation},
  author={Clinical Toxicologists},
  journal={Journal of Toxicology: Clinical Toxicology},
  year={2004},
  volume={42},
  pages={843 - 854}
}
Whole bowel irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that WBI improves the outcome of the poisoned patient. Based on volunteer studies, WBI should be considered for potentially toxic ingestions of sustained‐release or enteric‐coated drugs particularly for… 
Morbidity associated with whole bowel irrigation.
TLDR
Comment on the morbidity resulting from whole bowel irrigation (WBI) and applaud the authors for not only discussing the cardiotoxicity of bupropion, but also finding great value in describing the harm that may follow WBI in a patient with questionable and theoretical indications.
A retrospective review of whole bowel irrigation in pediatric patients
TLDR
A retrospective chart review of California Poison Control System electronic database for human poisoning cases between the years 2000 and 2010 found transient adverse drug reactions, vomiting and abdominal pain, were associated with WBI.
Whole bowel irrigation (WBI) in acute iron poisoning — case report
TLDR
WBI seems to be beneficial in early stage of iron intoxication ensuring rapid and effective cleansing of gut, and decreasing toxin absorption, as well as providing supportive care and avoiding deferoxamine treatment.
Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patients
TLDR
WBI can facilitate removal of select toxicants from the gastrointestinal tract in some patients, but there is no convincing evidence from clinical studies that it improves the outcome of poisoned patients.
Successful whole bowel irrigation in self-poisoning with potassium capsules
TLDR
A 28-year-old woman who was admitted on three occasions because of self-poisoning with potassium capsules and was successfully treated twice with WBI is presented.
Management of an Oral Ingestion of Transdermal Fentanyl Patches: A Case Report and Literature Review
TLDR
Successful management of a case of transbuccal and gastrointestinal ingestion of fentanyl patches and the management of such ingestion is reported utilizing whole bowel irrigation along with intravenous push and continuous infusion naloxone.
Gastrointestinal decontamination in the acutely poisoned patient
TLDR
The literature suggests that previously, widely used, aggressive approaches including the use of ipecac syrup, gastric lavage, and cathartics are now rarely recommended and limited use of GI decontamination of the poisoned patient is supported.
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References

SHOWING 1-10 OF 43 REFERENCES
Five days of whole-bowel irrigation in a case of pediatric iron ingestion.
Efficiency of whole bowel irrigation with and without metoclopramide pretreatment.
Whole bowel irrigation and the cocaine body-packer: a new approach to a common problem.
Whole bowel irrigation as a decontamination procedure after acute drug overdose.
TLDR
Whole bowel irrigation is an effective and safe gastrointestinal decontamination procedure for acute drug ingestion and there were no significant changes in body weight, hematocrit, serum electrolytes, or osmolality.
Use of whole bowel irrigation in an infant following iron overdose.
Multiple-dose charcoal and whole-bowel irrigation do not increase clearance of absorbed salicylate.
TLDR
The data do not support the use of either MDC or WBI to enhance the excretion of previously absorbed salicylate in poisoned patients, and in patients with drug overdoses, a clear rectal effluent remains as the endpoint for WBI.
Whole bowel irrigation for toxic ingestions.
  • M. Tenenbein
  • Medicine
    Journal of toxicology. Clinical toxicology
  • 1985
TLDR
Whole bowel irrigation was felt to be efficacious in this series, but requires additional study as a therapeutic approach to the patient who has ingested a toxic substance.
Whole bowel irrigation in an acute oral lead intoxication.
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