What is the role of whole-bowel irrigation in the treatment of calcium channel blocker (CCB) toxicity?

Updated: Jan 04, 2021
  • Author: B Zane Horowitz, MD, FACMT; Chief Editor: Michael A Miller, MD  more...
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Answer

If a patient has ingested a large number of CCB tablets, especially sustained-release tablets, the pills may aggregate to form bezoars and can be continuously absorbed for long periods. In this situation, the clinician may consider whole-bowel irrigation with polyethylene glycol (PEG). In adults, administer PEG at a rate of 1-2 L/h for 4-6 hours or until rectal effluent becomes clear.

Whole-bowel irrigation is absolutely contraindicated if bowel sounds are absent. This suggests that an ileus, secondary to shock or drug toxicity, has occurred. In these circumstances, large volumes of intestinal fluid lead to massive bowel distention, risking bowel perforation.

Coadminister activated charcoal in a 1 g/kg initial dose; activated charcoal administration can be repeated every 4 hours at half the initial dose. Because gastric emptying may be delayed, activated charcoal may be considered even if the patient presents several hours after the ingestion.

In children, care must be used never to administer sorbitol-containing products, because of the potential to induce electrolyte disturbances. In the rare instance of large ingestion in a preschool-age child, whole-bowel irrigation with PEG solution (Go-Lightly) may be used.


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