Ileus medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

The majority of cases of ileus are resolved with correction of underlying electrolyte disorder and only require supportive care. Intravenous hydration is advised with appropriate rapid supplementation for electrolyte abnormalities. NSAIDs are used as baseline analgesic medications. In contrast, opiates and antimotility drugs (such as vagolytic agents) should be avoided generally, although opiates are sometimes used in case of severe intractable pain. Patients are put on NPO and nasogastric tube is advised to relieve recurrent vomiting or abdominal distention associated with pain. Prokinetic agents such as erythromycin are not routinely recommended. In paralytic ilues certain medications such as hyoscyamine, methscopolamine bromide, oxycodone, polyethylene glycol-electrolyte solution (PEG-ES) are contraindicated.

Medical therapy for ileus includes correcting the underlying condition and supportive therapy.^[1][2][3][4]

• Patients should receive intravenous hydration.
• Patients of ileus from electrolyte abnormalities should be treated with appropriate supplementation.
• Bowel rest and nasogastric decompression can relieve recurrent vomiting or abdominal distention associated with pain.^[5][6]
• Antimotility drugs (such as vagolytic agents (butylscopolamine) and other medications (narcotics) which may alter intestinal motility should be stopped.
• Prokinetic agents such as erythromycin are not routinely recommended.
  • 1.1 – Post-operative pain
    • Preferred regimen (1): Acetaminophen 1000 mg orally every six hours (or IV when patient is NPO).
    • Preferred regimen (2): Add diclofenac 50 mg orally twice a day with meals for two days and adjust as-needed.
    • Preferred regimen (3): Add oxycodone 5 to 10 mg orally every three hours as needed for breakthrough pain.
    • Alternate regimen (1): Hydromorphone 0.2 to 0.5 mg IV every four hours as needed for severe breakthrough pain not responsive to oral medications.
  • 1.2 Fluid replacement
    • Preferred regimen (1): Isotonic saline (1 to 2 liters) to relieve symptoms.

      Note (1): Rapid infusion of isotonic fluid is advised until symptoms resolve.

  • 1.3 Recurrent vomiting or abdominal distension
    • Preferred regimen (1): Nasogastric (NG) tube placement until symptoms resolve.

      Note (1): The tip of NG tube should be placed in the stomach.

      Note (2): To prevent fluid loss, volume of fluid removed should be replaced with isotonic saline.

Paralytic ileus is considered an absolute contraindication to the use of the following medications:

• Hyoscyamine
• Methscopolamine bromide
• Oxycodone
• Polyethylene glycol-electrolyte solution (PEG-ES)

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