Canadian antidote guide

Polyethylene glycol

• PEG+electrolytes
• PEG-ELS
• PEG-ES
• Polyethylene glycol with electrolytes
• Colyte^®
• Golytely^®
• Peglyte^®

Whole bowel irrigation (WBI) using an oral polyethylene glycol electrolyte solution should be considered in cases of:

• Ingestion of a potentially toxic substance not adsorbable by activated charcoal (see the list), or
• Ingestion of a potentially toxic substance capable of forming clusters or bezoars (e.g. enterosoluble or sustained release drugs), or
• Ingestion of a blunt toxic foreign body (e.g. packet of street drugs or body packing)

AND

• Airways are protected naturally (or by endotracheal intubation, after consultation with your poison centre, and
• the clinician is confident that WBI will be administered until end of treatment, without early termination, and
• If there are no contra-indications (intestinal obstruction, hemodynamic instability, ileus)

• Nausea, vomiting, bloating, abdominal cramps.
• Regurgitation, aspiration pneumonia.
• Mild metabolic acidosis or electrolyte imbalances may occur through losses due to osmotic diarrhea.

• Stools
• Gastrointestinal symptomatology
  • If vomiting, consider administering an antiemetic.
  • If persistent, decrease the rate of administration of oral solution by 50% for 30 to 60 min, then return to the initial rate.
• Medical imaging in cases of bodypacking or bodystuffing.

• WBI is considered complete when the effluent is clear, which in general takes 4 to 6 hours, but  in some cases may take over 24 hours.
• For cases of body packing or body stuffing: when there is evidence of complete removal of drug packets.
• WARNING: If therapy is discontinued prematurely, the impact of WBI is unknown and it is believed that the PEG+electrolytes solution could then act as a solvent, thus promoting the dissolution of the toxin, potentially increasing its absorption.

Pediatric-Whole-bowel irrigation protocol:

• Whole-bowel irrigation with a feeding pump

Adult-Whole-bowel irrigation protocols:

• Whole-bowel irrigation by gravity
• Whole-bowel irrigation with a feeding pump

Enteral route

• NGT tube
  • Preferred route.

Reconstitution

• To prepare the oral solution, add tap water up to the fill line (total volume 4 L).
• Replace cap tightly, and mix well until completely dissolved.

Compatibility

• Altered effectiveness of activated charcoal when used concomitantly.

Stability      

• Keep unreconstituted product at room temperature.
• Once unreconstituted, the product is generally stable for 2 days at room temperature or 30 days in the refrigerator.

• Colyte, 4 L, Pd. oral, Pendopharm/Pharmascience DIN 00677442,
• Golytely, 4 L, Pd. oral, Braintree Laboratories Inc. DIN 00652512,
• Peglyte, 4 L, Pd. oral, Pendopharm/Pharmascience DIN 00777838, 
• Kangaroo™  ePump Enteral Feed and Flushs Pumps
  • Product number:  482400
• kangaroo™ ePump Enteral Feeding Sets (1 L bag with tubing)
  • Product number: 773656
• Kangaroo™ PEG Adapter with ENFit Connection
  • Product number (20Fr):Z8884752042E
  • Product number (16Fr): Z8884751622E
• Kangaroo™ Enteral Feeding Gravity set (1 L bag with tubing)
  • Product number: 8884702500

• At least 36L.

Bretaudeau Deguigne, M., J. F. Hamel, D. Boels, and P. Harry. 2013. “Lithium Poisoning: The Value of Early Digestive Tract Decontamination.” Clinical Toxicology 51 (4):243–48.



Thanacoody, Ruben, E. Martin Caravati, Bill Troutman, Jonas Höjer, Blaine Benson, Kalle Hoppu, Andrew Erdman, Regis Bedry, and Bruno Mégarbane. 2015. “Position Paper Update: Whole Bowel Irrigation for Gastrointestinal Decontamination of Overdose Patients.” Clinical Toxicology 53 (1):5–12.