Polyethylene glycol-electrolyte solution for intestinal clearance in children with refractory encopresis. A safe and effective therapeutic program
K. B. Ingebo and M. B. Heyman
Department of Pediatrics, University of California, San Francisco.
Severely constipated children with encopresis in whom outpatient management
has failed frequently require several days of hospitalization, as well as
conventional treatments involving cathartics and enemas. A balanced
electrolyte solution of the nonabsorbable polymer polyethylene glycol
(GoLytely, Braintree [Mass] Laboratories Inc) offers a safe and efficient
method for clearing the intestine. Twenty-four patients with a mean age of
8.1 years (range, 0.8 to 17.6 years) and an average weight of 31.5 kg
received polyethylene glycol-electrolyte solution: eight patients with
encopresis were given it as treatment for severe fecal retention
unresponsive to outpatient management; the other 16 were being prepared for
colonoscopy. Weight, complete blood cell count, and serum electrolyte,
serum urea nitrogen, and serum creatinine levels were measured before
solution administration and two hours afterward. Abdominal roentgenograms
were obtained from the encopretic patients. The two groups were comparable
in age and weight. Polyethylene glycol-electrolyte solution was given at a
rate of 14 to 40 mL/kg/h until clear fluid was excreted through the rectum.
Intestines were cleaned out successfully in all patients, and side effects
were minimal. Children with encopresis required an average of 11.8 L (574
mL/kg) given over 22.5 hours, while the other children needed only 4.0 L
(128 mL/kg) given over 7.5 hours. Weight and serum electrolyte and
creatinine levels did not change significantly in any patient. The
hematocrit decreased only in encopretic patients (0.38 to 0.36 [37.6% to
35.8%]) and the serum urea nitrogen level decreased in the patients
undergoing colonoscopy (3.6 to 2.0 mmol/L [10 to 8 mg/dL]).
