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management of bowel obstruction without a tube
Management:
In palliative medicine:
1) NG tubes are uncomfortable & may increase secretions
2) most palliative care patients are not surgical candidates
3) parenteral nutrition & intravenous rehydration is almost always reserved for surgical candidates
- parenteral nutrition for surgical candidates with complete or partial bowel obstruction [3]
4) reduce intestinal secretions
- glycopyrrolate 0.2-04. mg SC every 2-3 hours
5) for partial obstruction, attempt reversal (especially if functional)
a) continue stimulant/bulk combination agents
b) octreotide
1] 5-10 ug/hr to start
2] 250-750 ug/day, continuously
6) for complete bowel obstruction, put the bowel to rest
a) morphine IV or other opiate
b) scopolamine
1] 0.8-2.4 mg QD
2] Transderm Scop 0.3 mg/24 hours (delayed effect)
c) hyoscyamine 0.125 mg SL every 3-4 hours
d) haloperidol 5-10 mg/24 hours
General
management
References
- Frederich M., Multicampus Program in Geriatrics & Gerontology,
Syllabus: The Cutting Edge in Palliative Medicine, 2001
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013
- NEJM Knowledge+