CDU Interventions

• Mobilize Patient

  • If mobile patient should take a walk with CNA/Tech at least TID

  • If patient is less mobile consider PT consult for mobilization

• Medications

  • Osmotic Laxative - Miralax (PEG) 

    • Milder cases - 17 grams twice daily

    • Severe - Golytely (4000 ml) overnight

  • Motility Agents

    • Biscodyl 15 mg PO daily

    • Senna 8.6 mg two tablets (17.2 mg) twice daily

  • Anti-Emetics

    • Prefer Metoclopramide (10 mg orally) given motility benefit

  • Opiate Antagonists - If patient is on opiate therapy

    • Naloxegol 25 mg once daily

    • Methylnaltrexone (Relistor) 12 mg SQ once

• Stool Dis-Impaction (from below)

  • Repeat Manual Disimpaction as necessary

  • Enemas

    • Tap water, Soap Suds, or Lactulose Enemas PRN

    • Avoid Sodium Phosphate (FLEET) enema in the elderly, associated with severe electrolyte derangement

    • Consider an "Enhanced Enema" (see below)