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what is the recipe for the “bomb enema” that zdogg spoke of.? like, how much glycerin and in what form and who much mag citrate and how much whatever else ?
i would also like to make a plug (pun intended) for milk and molasses enema- we use one cup of whole milk and one cup molasses warmed in a microwave.
also, i was a little confused about the electrolyte free vs electrolyte containing forms of peg. can you explain or provide a reference? what is in the traditional go lytley.?what is the advantage of either?
btw, loved the pod cast-my favorite to date. i laughed re. the disimpaction because i too always wondered where the section in Roberts and Hedges is on the proper technique. i often use ketafol to do it.
Hi Don, the deal with hyponatremia is that Miralax, which does not contain electrolytes, may lead to hyponatremia when ingested in large volumes. The problem, in theory, is that patients will consume too much free water on top of the PEG-water elixir that they are using for laxation. Go-lytely, which has added electrolytes such as sodium and potassium, is felt to decrease the risk. I personally don’t think there is much of a difference when the amount consumed is 1 glass per day, but when we get into disimpaction dosing, which involves many doses per day, the issue of free water consumption is more relevant.
I’ve been waiting years for this bit of excrement! So I’m not the only witless one sent into a room to clean a chute without a clue. Thanks for bringing light to a dark brown subject.
Recipe for Zdoggs bomb? How much glycerin and in what form? How much water ?
Regarding use of narcan in post op patients on opiates for pain. Are you aware of anyone using this as part of a preventive cocktail to prevent constipation? What do you think?
Hi Ron- Out of all the articles I read for the constipation manifesto, this one most closely matches your question. The only form of naloxone we have available in our hospital is the liquid that’s either in a syringe of vial, which would make it hard to send home with patients. That being said, mechanistically, it makes much more sense using naloxone than using laxatives, since we could prevent the problem at the receptor level.
I’m confused about the PO from of Narcan. Is there a PO from of Narcan in the U.S. or is IV Narcan simply given PO. I tried to ask the pharmacist of my hospital about PO narcan and they very snarkily stated that it does not exist.
A PO form of naloxone is not available in my hospital either. The IV stuff you use every day for narcotic ODs will work just fine. I put 2mg in apple juice and have the patient drink it in the ED before they go home. The big question is …. does this single bolus of naloxone (at this dose) really work. The studies looking at PO narcan to relieve narcotic induced constipation used, for the most part, higher doses at higher frequency. The down side of that is that the higher the dose, the higher the liklihood of withdrawal symptoms.