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.