Constipation
-Inevitably, you will often get called in the middle of the night for this complaint
-Most people are on colace 100mg BID – this is basically fiber & does not help people once they are already constipated. It is not a bad thing to put people on when they get admitted to try to keep them regular, but not very effective overall.
-When you order things for constipation, order them standing, NOT prn…..otherwise the patients will only get it when they ask for it, at which point it might be too late. But you should put in the comments “patient may refuse.”
-The following is a list is in the order you can usually prescribe, but everyone has their own style…..
▪ Senna 17.2mg (2x8.6 tabs) PO q12, then q6
▪ Bisacodyl 10mg PO q12 (max 30mg/day) or 10mg PR q12 (max 30mg/day)
▪ MgCitrate 1 bottle daily/q12 (be careful in people with renal failure as this has a lot of Mg)
▪ Tap water enema x3 (~500Ml each)
▪ Lactulose 20mL q6 hrs till BM
▪ Fleets enema (again, not to use in renal failure) x 1 or 2
-ANY patient on opioids should be on an aggressive bowel regimen from day 1 to prevent constipation. In these patients, you can order Colace 100mg PO q12 standing, senna 17.2mg q12 standing & Bisacodyl 10mg PO q12 standing.