Five Days of Whole-Bowel Irrigation in a Case of Pediatric Iron Ingestion

The maximum duration and volume of polyethylene glycol electrolyte solution (PEG-ELS) that can be safely administered during whole-bowel irrigation of the poisoned patient are poorly defined. We present a case of a 33-month-old boy who ingested at least 160 mg/kg elemental iron and received 44.3 L of PEG-ELS (2,953 mL/kg) over 5 days because of the persistence of iron tablets in the gastrointestinal tract. The child remained clinically well after initiation of PEG-ELS therapy, and further significant iron absorption did not appear to occur. The rectal effluent cleared within 2 days of the start of PEG-ELS therapy despite the persistence of iron in the gastrointestinal tract as shown on radiography. No adverse effects resulted from the large volume or duration of the PEG-ELS therapy. This is the greatest reported volume of PEG-ELS to be used for whole-bowel irrigation in the treatment of a toxic ingestion. [Kaczorowski JM, Wax PM: Five days of whole-bowel irrigation in a case of pediatric iron ingestion. Ann Emerg Med February 1996;27:258-263.]