Laxative of choice in the ER

[waterski232002]

What is your laxative of choice in the ER for quick relief of constipation? I like using Miralax or mag citrate, but it can take many hours to work. Nurses at my hospitals hate giving enemas....

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[mikecwru]

What is your laxative of choice in the ER for quick relief of constipation? I like using Miralax or mag citrate, but it can take many hours to work. Nurses at my hospitals hate giving enemas....

I use those frequently but I don't give them in the ED. People tend to like to crap at home.

mike

 

[Dimoak]

I use those frequently but I don't give them in the ED. People tend to like to crap at home.

mike

I believe that Mineral Oil enemas are by far the fastest way to induce a bowel movement, but may not necessarily relieve a more "sizable" constipation.

Polyethylene glycol 3350 (MiraLax) is actually classified as a therapeutic agent for constipation, while enemas I believe are classified as Laxatives/Cathartics. But an enema can still help your pt feel better more rapidly while the MiraLax is working; if you feel an enema is necessary and will help make your pt better, the nurses should administer it, as after all, it's in the pt's best interests, right?

 

[Apollyon]

Constipation relief is not an ED procedure. Some community hospitals will admit (!) patients that are constipated, but, if you are at all busy, give patients an Rx and go. As mike said, people like to dump at home, and, also, it's variable when it will work.

 

[r54918]

It may not be an "EM procedure", but may help sort out the cause of non-specific abdominal pain and prevent an unneccesary admission. If you have a patient with mild distension, abdo cramping, good bowel sounds with a benign abdominal exam and suspect constipation, then administer a laxative. If the patient has relief after a BM, you're done and send home. If your patient does still has abdominal pain, you'll need to re-think the etiology.

Does anyone else do this?

 

[stoic]

It may not be an "EM procedure", but may help sort out the cause of non-specific abdominal pain and prevent an unneccesary admission. If you have a patient with mild distension, abdo cramping, good bowel sounds with a benign abdominal exam and suspect constipation, then administer a laxative. If the patient has relief after a BM, you're done and send home. If your patient does still has abdominal pain, you'll need to re-think the etiology.

Does anyone else do this?

keeping them around might make sense if you have reason to suspect something more serious that you want to rule out (and if so, would this be the best way to find out)? but if you dx constipation, then why have them tie up a bed for several hours while they wait to take a crap. i say send them home!

 

[GeneralVeers]

keeping them around might make sense if you have reason to suspect something more serious that you want to rule out (and if so, would this be the best way to find out)? but if you dx constipation, then why have them tie up a bed for several hours while they wait to take a crap. i say send them home!

I say send them home too! With our patients, they will more likely than not just take a dump in their hospital gurney. Better on my nose, and for the nurses if they do that outside the hospital.

 

[mikecwru]

It may not be an "EM procedure", but may help sort out the cause of non-specific abdominal pain and prevent an unneccesary admission. If you have a patient with mild distension, abdo cramping, good bowel sounds with a benign abdominal exam and suspect constipation, then administer a laxative. If the patient has relief after a BM, you're done and send home. If your patient does still has abdominal pain, you'll need to re-think the etiology.

Does anyone else do this?

I send them home. Why not give them the rx, send them home, and give them good return instructions to look for?

The one exception to this is old people. I have a very low threshold to watch/admit old people, because the chances of a surgical diagnosis/serious diagnosis are relatively much higher and the diagnosis of "constipation" is a dangerous one, just like "gastroenteritis" is a dangerous diagnosis in kids.

mike

 

[Apollyon]

It may not be an "EM procedure", but may help sort out the cause of non-specific abdominal pain and prevent an unneccesary admission. If you have a patient with mild distension, abdo cramping, good bowel sounds with a benign abdominal exam and suspect constipation, then administer a laxative. If the patient has relief after a BM, you're done and send home. If your patient does still has abdominal pain, you'll need to re-think the etiology.

Does anyone else do this?

This is after you've ruled out the bad stuff. In the Slovis/Wrenn book of emergency medicine secrets, they say that the elderly have been dealing with constipation their whole lives - if they come in, look for more. Just calling it 'constipation' could be the last dx they get.

My post referred to the strictly constipated - not the colon Ca, AAA, diverticulitis, volvulus, lymphoma, other Ca's, Meckel's, or any other dx/zebra.

 

[bartleby]

Does anyone else do this?

No. Therapeutic trials to determine etiology of a complaint and disposition are a bad idea in general, no less so in the case of an 80 year old with abdominal pain and "consitpation". How long are you going to wait for your laxative to take effect? 2 hours? 10? What if they have a bowel movement and they're not sure if they feel better?

If you have done an assessment of a patient with simple constipation which you feel is benign in etiology and they are not in need of manual disimpaction, their toilet works just as well at home as in the ED.

 

[doctawife]

The peds literature has a lot on this topic. Basically, you have to remove the 'plug' of poop, then soften the poo while establishing a rational and sane bowel regimine.

But basically, if you come to the ER I'm working in, and your problem is constipation, you're getting an enema and a script for Miralax. If I think you're not gonna get the Miralax, I'll also give you instrstions for copious amounts of Milk of Mag.

As one of my critical care colleages told me, one teaspoon of Milk of Mag every hour until result. Works every time, even on MRCP kiddos.

 

[Homunculus]

if available, try dropping a fresh 24 week preemie in their lap. that makes me **** my pants every time

if that doesn't work, tell them that kungfufishing made it through college, made it through medical school, and is now a licensed physician in an ED residency and may treat them someday. this will also cause immediate pants shatting every time

--your friendly neighborhood future peds GI (fingers crossed) caveman

 

[Homunculus]

The peds literature has a lot on this topic. Basically, you have to remove the 'plug' of poop, then soften the poo while establishing a rational and sane bowel regimine.

But basically, if you come to the ER I'm working in, and your problem is constipation, you're getting an enema and a script for Miralax. If I think you're not gonna get the Miralax, I'll also give you instrstions for copious amounts of Milk of Mag.

As one of my critical care colleages told me, one teaspoon of Milk of Mag every hour until result. Works every time, even on MRCP kiddos.

the clean out then maintenence. part of bread and butter peds, lol. miralax is awesome stuff it's titratable, which parents like; and has no systemic effects. it's expensive (or so i hear) but being military we give our patients meds for free. trust me, it's one of the few perks though.

--your friendly neighbohood regular caveman

 

[totalbodypain]

What is your laxative of choice in the ER for quick relief of constipation? I like using Miralax or mag citrate, but it can take many hours to work. Nurses at my hospitals hate giving enemas....

I don't take laxatives at work. It seems to slow me down (or speed me up...), and the patients appreciate it more when I don't have to run off to the crapper mid H/P. Besides the ER is not the appropriate place to go to relieve constipation (or diagnosis it for that matter) for me or my patients...