![]() Recommend 1-2 Fleet Enemas daily for the next 2 days Advise the patient to mix 3-4 17g doses of Polyethylene Glycol daily until a soft stool is produced and then mix 1 17gdose daily for 3-4 weeks Provide 1/2 bottle (8oz or ~250mL) of Magnesium Citrate orally in the ED Perform manual disempaction if indicated by stool in the rectal vault (the podcast has a great overview of an approach for this procedure) Wall’s Constipation Cocktail (aka the Orange Poly-Fleet – sounds yummy): Thanks to Rob Orman for his excellent podcast and Dr. Rather than coming up with my own untested Cocktail, I have adopted one that I was introduced to through #FOAMed on ERCast’s Constipation Manifesto podcast. My goal for this post is to delve into a Constipation Cocktail in sufficient depth to adopt it for my own practice (and maybe yours?). I really wish I could just order up some lactu-seno-pico-glycol and let ‘er buck, but because I can’t it’s time to learn about it: BoringEM Style. To make up for my ignorance, I have developed coping/survival strategies such as ordering whatever the nurses on the ward ask for (at least that way if it doesn’t work it’s not blamed on me) and, when in the ED, picking something the patient hasn’t already tried and sending them home to deal with their situation in precious privacy. Poop, like me, doesn’t make it onto EMCrit. This has given me some experience with many treatments but minimal experience with any specific one. Constipation cocktails seem to be as numerous as the bartenders that mix them with many doctors having their own “special recipe” and different services (ie gen surg vs peds vs obstetrics vs internal medicine) having different approaches at my institution. In the ER, I don’t know if my remedies worked or not unless there were instant results because my follow-up of constipation cases is nonexistent. On the wards the nurses are monitoring the patient’s bowels and noting what treatments have been tried and worked (or didn’t). As a resident on the ward, I don’t actually take care of constipation. While I have diagnosed and treated constipation, I didn’t have a great understanding of the treatment options or have a good Cocktail of my own. Help them Obi-Wan Kenobi, you’re their only hope. Regardless, they’re sick and tired of it and they want YOU to fix it. Regardless, it’s no fun to deal with for the nurses, the doctor or (most importantly) the patient. Those that don’t are diagnosed through a combination of clinical acumen, exclusion and a FOS x-ray. Those that know they’re constipated come in as a last resort after trying the homemade remedies they saw on Dr. ![]() The constipated patients that present to the ED take this everyday ailment to a whole new level. ![]() And it may absorb well, per a small February 2018 study in the Journal of the American College of Nutrition, which compared a placebo to a supplement of magnesium malate combined with vitamins B6, B12 and folate.Constipation, as defined succinctly by Urban Dictionary, is when you’ve gotta go, but your ass says “no!” It is a diagnosis that I can truly empathize with – who hasn’t been at least a bit bunged up before? Magnesium malate: This variety doesn't have a laxative effect, per the American Association for the Study of Liver Diseases.It has few side effects and is gentle on the stomach, Dr. Magnesium glycinate benefits include a potential reduction in anxiety, depression and insomnia - but more research is needed. Magnesium glycinate: Another option that absorbs well, Werkheisererk says. Magnesium sulfate: You likely know this better as Epsom salt, the product you add to the bath to soothe achy and sore muscles, Werkheiser points out. Magnesium chloride: This well-absorbed option is often used to treat low magnesium levels, Werkheiser says.While it doesn't absorb well, it's "often used for short-term relief of digestive issues including indigestion and constipation," Werkheiser says. ![]() ![]() Magnesium oxide: You may know this better as milk of magnesia. Magnesium citrate: This type is affordable and easily absorbed, and is often used to treat constipation, says dietitian Rachel Werkheiser, RD of the hospitality group Sodexo Healthcare. ![]()
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