Ileus medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Nil per os (NPO or Nothing by Mouth) is mandatory in all cases. Nasogastric suction and parenteral feeds may be required until passage is restored. There are several options in the case of paralytic ileus. Most treatment is supportive. If caused by medication, the offending agent is discontinued or reduced. Bowel movements may be stimulated by prescribing lactulose, erythromycin or in severe cases, (Ogilvie's syndrome) neostigmine. If possible the underlying cause is corrected (e.g. replace electrolytes).
Medical Therapy
Medical therapy for ileus includes correcting the underlying condition and supportive therapy.[1][2][3]
- Patients should receive intravenous hydration.
- Patients of ileus from electrolyte abnormalities should be treated with appropriate supplementation.
- Bowel rest and nasogastric decompression can relieve recurrent vomiting or abdominal distention associated with pain.
- Antimotility drugs and other medications (narcotics) which may alter intestinal motility should be stopped.
- Prokinetic agents such as erythromycin are not routinely recommended.
- 1.1 - Post-opertaive pain
- Preferred regimen (1): Acetaminophen 1000 mg orally every six hours (or IV incase patient is NPO).
- Preferred regimen (2): Add diclofenac 50 mg orally twice a day with meals for two days and adjust as-needed.
- Preferred regimen (3): Add oxycodone 5 to 10 mg orally every three hours as needed for breakthrough pain.
- Preferred regimen (4): Hydromorphone 0.2 to 0.5 mg IV every four hours as needed for severe breakthrough pain not responsive to oral medications
- 1.1.2 Fluid replacement
- 1.1.2 Adult
- Preferred regimen (1): Isotonic saline (1 to 2 liters) to relive symptoms
- Note (1): Rapid infusion of isotonic fluid is advised until symptoms resolve
- 1.1 - Post-opertaive pain
Contraindicated medications
Paralytic ileus is considered an absolute contraindication to the use of the following medications:
References
- ↑ Bruns BR, Kozar RA (2016). "Feeding the Postoperative Patient on Vasopressor Support: Feeding and Pressor Support". Nutr Clin Pract. 31 (1): 14–7. doi:10.1177/0884533615619932. PMID 26703957.
- ↑ Cali RL, Meade PG, Swanson MS, Freeman C (2000). "Effect of Morphine and incision length on bowel function after colectomy". Dis. Colon Rectum. 43 (2): 163–8. PMID 10696888.
- ↑ Wu Z, Boersema GS, Dereci A, Menon AG, Jeekel J, Lange JF (2015). "Clinical endpoint, early detection, and differential diagnosis of postoperative ileus: a systematic review of the literature". Eur Surg Res. 54 (3–4): 127–38. doi:10.1159/000369529. PMID 25503902.