Bowel obstruction medical therapy

Bowel obstruction Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

The mainstay treatment of bowel obstruction is surgical and non-operative management. The role of medical therapy is supportive and is limited by palliative pain management in cancer patients, fluid and electrolyte replenishment, decreasing abdominal distension, peritumoral edema, intraluminal secretions, peristaltic movements, and control of nausea and vomiting.

Medical Therapy

The mainstay treatment of bowel obstruction is surgical and non-operative management. The role of medical therapy is supportive and is limited by control of vomiting and nausea, fluid and electrolyte replenishment, palliative pain management in cancer patients, decreasing abdominal distension, peritumoral edema, intraluminal secretions, and peristaltic movements.

• '1 Antiemetics
  • 1.1 Antiemetics in cancer patients
    • 1.1.1 Adult

      • Note (1): Used in conjunction with nasogastric decompression

      • Preferred regimen (1): Haloperidol 0.5 -2 mg and up to 20 mg PO q6h IV or SC
      • Preferred regimen (2): Dexamethasone 4 mg q12h IV or SC
      • Preferred regimen (3): Octreotide 0.1 mg and up to 0.3 mg q8h IV or SC
      • Alternative regimen (1): Hyoscine (scopolamine) hydrobromide 0.2 - 0.4 mg q6 - 8h SC or transdermal
      • Alternative regimen (2): Chlorpromazine, prochlorperazine, or cyclizine 0.2 - 0.4 mg q6 - 8h SC or IV or rectally
    • 1.1.2 Antiemetics in non-cancer patients
      • Preferred regimen (1): Promethazine 12.5-25 mg q4 - 6h PRN or PO, alternatively 12.5-25 mg q4 - 6h IV or IM
      • Preferred regimen (2): Ondansetron 4 - 8 mg q8-12hr PO or IV
    • 1.1.3 Pediatric
      • 1.1.3.1 Children 1 month - 12 years of age
        • Preferred regimen (1): Ondansetron <40 kg, 0.1 mg/kg IV
        • Preferred regimen (2): Ondansetron >40 kg, 4 mg IV
      • 1.1.3.1 Children < 2 years of age
        • Preferred regimen (1): Promethazine - contraindicated
      • 1.1.3.2 Children > 2 years of age
        • Preferred regimen (1): Promethazine 0.25-1 mg/kg PO/PR q4-6hr; not > 25 mg
      • 1.1.3.2 Children > 12 years of age
        • Preferred regimen (1): Ondansetron 4 mg IV/IM or 16 mg PO 1 hr
• 2 Fluid and electrolyte replacement
  • 2.1 Fluid replacement
    • 2.1.1 Adult
      • Parenteral regimen
        • Preferred regimen (1): Isotonic saline or lactated Ringer solution 1 - 2 L IV initially, in addition to administration of fluid equal to the urine output plus insensible fluid losses (approx. 30 - 50 ml)
    • 3.1 Electrolyte replacement
      • Hyponatremia
        • Preferred regimen (1): Sodium Potassium 40 mEq/L or 2.25 g per L
      • Hypokalemia

    Note (1): Replacement is only necessary if deficit continues for >48h, or in excess of 2L in 24h

    • • • Preferred regimen (1): Potassium 40 mEq/L or 3.0 g per L not > 80 mEq/L

**** Hypochloremia

• • • • • Preferred regimen (1): Chloride 40 mEq/L not> 80 mEq/L
  • 2.2 'Other Organ system involved 2'

    Note (1):

    Note (2):

    Note (3):

    • 2.2.1 Adult
      • Parenteral regimen
        • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
        • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
        • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
      • Oral regimen
        • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
        • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
        • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
        • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
        • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
        • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
    • 2.2.2 Pediatric
      • Parenteral regimen
        • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
        • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
        • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
      • Oral regimen
        • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
        • Preferred regimen (2): drug name 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
        • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
        • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
        • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
        • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)

References

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