Bowel obstruction medical therapy

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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)
    • 2.2 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
• 3 Pain management in cancer/non-cancer patients
  • 3.1 Non-opioids
    • 3.1.1 Adult
      • Parenteral regimen
        • Preferred regimen (1): Acetaminophen 325–1000 mg PO q4–6h PRN
        • Alternative regimen (2): Aspirin 325–650 mg PO q4h PRN
        • Alternative regimen (3): Diclofenac 50 mg PO BID-TID
        • Alternative regimen (3): Etodolac 200–400 mg PO q6–8h
        • Alternative regimen (4): Ibuprofen 400–600 mg POq 4–6h PRN
        • Alternative regimen (5): Indomethacin 25–50 mg PO TID
        • Alternative regimen (6): Ketoprofen 25–50 mg PO q6h–q8h
        • Alternative regimen (7): Ketorolac 10 mg PO q4–6h PRN or 30 mg IV/IM q6h
        • Alternative regimen (8): Meclofenamate 50–100 mg PO q4–6h PRN
        • Alternative regimen (9): Mefenamic acid 250 mg PO q4–6 PRN
        • Alternative regimen (10): Meloxicam 7.5–15 mg PO once daily
        • Alternative regimen (11): Nabumetone 100–2000 mg once daily
        • Alternative regimen (12): Naproxen 250–500 mg PO BID
        • Alternative regimen (13): Oxaprozin 1200 mg PO once daily
        • Alternative regimen (14): Piroxicam 20 mg PO once daily
        • Alternative regimen (15): Sulindac 150–200 mg PO BID
        • Alternative regimen (16): Tolmetin 200–600 mg PO BID-TID
        • Alternative regimen (17): Tramadol 50–100 mg PO q4–6h PRN; 100 – 300 mg QD for SR
        • Alternative regimen (18): Celecoxib 200 mg PO BID
  • 3.2 Opioids

References

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