Golytely for constipation

[jessi1106, BSN, RN]

I had a very constipated pt recently.

I was giving second gallon of golyely through NGT.

Pt was also getting M &M enemas q shift.

Output was only liquid.

The oncoming nurse said that if we kept dumping golytely into pt we would perf her.

I am a new nurse...anyone seen this happen?

[Tash4nvyblues, RN]

No I have not seen that, but working in critical care, I have attended many patients who have arrested because the electrolytes had not been replaced while the patient was being treated for constipation. Believe me it happens very quickly.

[GeminiTwinRN, BSN]

Good lord. Something sounds very wrong here! Not only is that pt at risk for electrolyte imbalance, but if her stool was entirely liquid, that is usually the time to stop giving the golytely! Was her liquid stool clear?

I certainly hope that she had had xrays performed to ensure that she didn't have a stricture or other obstruction before ANY golytely was given!

This could turn into a really really bad outcome. I hope you documented very well. Surely the MD's were aware. I have never given golytely simply for constipation. It has always been given by me for bowel prep for scoping.. this just smells bad all around.

I'm sorry.

[TLCinCICU]

It's been a long while, but I have given Golytely for constipation in a chronic vent patient. It always worked very well for her and the MDs knew it. And I thought the "lyte" portion of the name meant that it was formulated to prevent electrolyte imbalances during the process of clearing the lower GI tract.

There are a few variables that aren't part of your story. Did the patient have bowel sounds? Does the patient have abdominal pain (which is very likely a "yes") Has an KUB or abdominal CT been done? Is there an ileus or small bowl obstruction?

[jessi1106, BSN, RN]

Thanks for the responses.

Pt stool was brown liquid, but abd was extremely hard and distended. (seemed like way more than liquid should have been coming out).

Yes pt had +bowel sounds, abd pain and abd ct. No ileus or SBO.

I work on a GI unit at a major hospital. The drs are usu. very good, but I had never seen Golytely given this way, in this amt. It is also July and the new docs are writing the orders.

I work tomorrow and will see how pt is doing.

[TLCinCICU]

I hope all worked out well for your patient. I would have been making certain the MD was knew of the belly assessment findings and only having liquid stool. I'm thinking that they must have been trying to avoid some complication by being that aggressive trying to get him/her to have a BM.

I kept thinking about other options. We have an NP that works with the intensivists on my unit. We tease her a bit about her emphasis on BMs, but she is correct in making it important. She starts many of our patients on Dulcolax and Senna PO BID. If it doesn't work, she doubles the "starter" dose. At 3 days of it not working (God forbid), she adds a daily Dulcolax suppository. What we occasionally get on the "unusual" side is when erythromycin is written in order to jumpstart someone's bowels. It's a lower dose than when treating infections, but it works like a charm. After all, have you ever seen anyone take erythromycin and NOT get diarrhea?