Abstract
Introduction
Effective whole bowel irrigation may be difficult in the presence of drug-induced ileus. Neostigmine, which inhibits the enzymatic degradation of acetylcholine, has been suggested to improve drug-induced ileus. We present two poisoning cases in which neostigmine was used to facilitate gut decontamination complicated by ileus.
Case Reports
A 47-year-old woman, after overdose with sodium valproate, venlafaxine, and ibuprofen, developed ileus that prevented whole bowel irrigation. Neostigmine, 2.5 mg intravenously followed by 1.25 mg three hours later, led to improved bowel transit and successful whole bowel irrigation. A 25-year-old man developed ileus after overdose with venlafaxine, dothiepin, and ethanol. Neostigmine administration led to improved intestinal motility and successful whole bowel irrigation.
Discussion
We demonstrate facilitated gut decontamination temporally associated with administration of neostigmine in two patients judged to have drug-induced ileus following overdose. No significant adverse events related to neostigmine were observed.
Keywords: neostigmine, ileus, venlafaxine, overdose
Full Text
The Full Text of this article is available as a PDF (148.7 KB).
References
- 1.Tenenbein M. Position statement: whole bowel irrigation. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 2000;38:689–690. doi: 10.1081/CLT-100102379. [DOI] [PubMed] [Google Scholar]
- 2.Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the Treatment of Acute Colonic Pseudo-obstruction. NEJM. 1999;341:137–141. doi: 10.1056/NEJM199907153410301. [DOI] [PubMed] [Google Scholar]
- 3.Van der Spoel JI, Oudemans-van Straaten HM, Stoutenbeek CP, Bosman RJ, Zandstra DF. Neostigmine Resolves Critical Illness Related Colonic Ileus in Intensive Care Patients with Multiple Organ Failure—a Prospective, Double-Blind, Placebo Controlled Trial. Int Care Med. 2001;27:822–827. doi: 10.1007/s001340100926. [DOI] [PubMed] [Google Scholar]
- 4.Isbister FK, Oakley P, Whyte I, Dawson A. Treatment of Anti-cholinergic Induced Ileus with Neostigmine. Ann Emerg Med. 2001;38:689–693. doi: 10.1067/mem.2001.119458. [DOI] [PubMed] [Google Scholar]
- 5.Olgilvie H. Large-Intestinal Colic due to Sympathetic Deprivation. A New Clinical Syndrome. BMJ. 1948;2:671–673. doi: 10.1136/bmj.2.4579.671. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Brubacher JR, Levine B, Hoffman RS. Intestinal pseudo-obstruction (Ogilvie’s syndrome) in theophylline overdose. Vet Hum Toxicol. 1996;38:368–70. [PubMed] [Google Scholar]
- 7.Amato CS, Wang RY, Wright RO, Linakis JG. Evaluation of Promotility Agents to Limit the Gut Bioavailability of Extended-Release Acetaminophen. J Toxicol Clin Toxicol. 2004;42:73–77. doi: 10.1081/CLT-120028748. [DOI] [PubMed] [Google Scholar]