BNF for Children 2011-2012

64 1.6.5 Bowel cleansing preparations BNFC 2011–20121 Gastro-intestinal systemRelaxit Micro-enema c (Crawford)Enema, sodium citrate 450 mg, sodium lauryl sulphate75 mg, sorbic acid 5 mg, together with glyceroland sorbitol in a viscous solution in 5-mL single-dosedisposable packs with nozzle. Net price 5 mL = 32pDose. By rectumChild 1 month–18 years 5 mL as a single dose (insertonly half nozzle length in child under 3 years)1.6.5 Bowel cleansingpreparationsBowel cleansing preparations are used before colonicsurgery, colonoscopy, or radiological examination toensure the bowel is free of solid contents. They arenot treatments for constipation.Cautions Bowel cleansing preparations should be usedwith caution in children, particularly in those with fluidand electrolyte disturbances. Renal function should bemeasured before starting treatment in patients at risk offluid and electrolyte disturbances. Hypovolaemiashould be corrected before administration of bowelcleansing preparations. Adequate hydration should bemaintained during treatment. Bowel cleansing preparationsshould be used with caution in colitis (avoid ifacute severe colitis), or in those who are debilitated.They should also be used with caution in patients withan impaired gag reflex or possibility of regurgitation oraspiration. Other oral drugs should not be taken onehour before or after administration of bowel cleansingpreparations because absorption may be impaired.Contra-indications Bowel cleansing preparations arecontra-indicated in patients with gastro-intestinalobstruction or perforation, gastric retention, acutesevere colitis, or toxic megacolon.Side-effects Side-effects of bowel cleansing preparationsinclude nausea, vomiting, abdominal pain (usuallytransient—reduced by taking more slowly), and abdominaldistention. Less frequent side-effects includeheadache, dizziness, dehydration, and electrolyte disturbances.MACROGOLSCautions see notes above; also heart failureContra-indications see notes above; also gastrointestinalulcerationPregnancy manufacturers advise use only if essential—noinformation availableBreast-feeding manufacturers advise use only ifessential—no information availableSide-effects see notes above; also anal discomfortLicensed use Klean-Prep c not licensed for use inchildrenIndication and doseSee preparationsKlean-Prep c (Norgine)Oral powder, sugar-free, macrogol ‘3350’ (polyethyleneglycol ‘3350’) 59 g, anhydrous sodium sulphate5.685 g, sodium bicarbonate 1.685 g, sodium chloride1.465 g, potassium chloride 743 mg/sachet, net price4 sachets = £8.23. Label: 10, patient informationleaflet, counsellingExcipients include aspartame (section 9.4.1)Electrolytes 1 sachet when reconstituted with 1 litre water provides Na +125 mmol, K + 10 mmol, Cl 35 mmol, HCO 320 mmolDoseBowel cleansing before radiological examination,colonoscopy, or surgery. By mouthChild 12–18 years a glass (approx. 250 mL) of reconstitutedsolution every 10–15 minutes, or by nasogastrictube 20–30 mL/minute, starting on the day before procedureuntil 4 litres have been consumed; alternatively,administration may be divided into two (2 litres ofreconstituted solution taken on the evening before procedureand 2 litres of reconstituted solution taken on themorning of procedure). Treatment can be stopped ifbowel motions become watery and clear. To facilitategastric emptying, domperidone (section 1.2) may begiven 30 minutes before startingDistal intestinal obstruction syndrome. By mouth, nasogastric or gastrostomy tubeChild 1–18 years 10 mL/kg/hour for 30 minutes, then20 mL/kg/hour for 30 minutes, then increase to 25 mL/kg/hour if tolerated; max. 100 mL/kg (or 4 litres) over 4hours; repeat 4-hour treatment if necessary.Administration 1 sachet should be reconstituted with 1 litreof water. Flavouring such as clear fruit cordials may be addedif required. Solid food should not be taken for at least 2 hoursbefore starting treatment. After reconstitution the solutionshould be kept in a refrigerator and discarded if unused after24 hours.MAGNESIUM CITRATEReconstitution of a sachet containing 11.57 g magnesium carbonateand 17.79 g anhydrous citric acid produces a solutioncontaining magnesium citrateCautions see notes aboveContra-indications see notes aboveHepatic impairment avoid in hepatic coma if risk ofrenal failureRenal impairment avoid if estimated glomerular filtrationrate less than 30 mL/minute/1.73 m 2 —risk ofhypermagnesaemiaPregnancy cautionBreast-feeding cautionSide-effects see notes aboveIndication and doseSee preparationsCitramag c (Sanochemia)Oral powder, sugar-free, effervescent, magnesiumcarbonate 11.57 g, anhydrous citric acid 17.79 g/sachet, net price 10-sachet pack (lemon and limeflavour) = £17.20. Label: 10, patient informationleaflet, 13, counselling, see belowElectrolytes Mg 2þ 118 mmol/sachetDoseBowel evacuation on day before radiological examination,colonoscopy, or surgery. By mouthChild 5–10 years on day before procedure, one-third ofa sachet at 8 a.m. and one-third of a sachet between 2and 4 p.m.