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Constipation — Discharge Treatment for Constipation — Clinical Pathway: Emergency Department and Inpatient

Constipation Clinical Pathway — Emergency Department and Inpatient

Discharge Treatment for Constipation

Maintenance Treatment for No Fecal Impaction or Treated Fecal Impaction

  • Discharge all patients on 1st line medications
    • Polyethylene glycol is preferred, may substitute with lactulose if family prefers or child cannot tolerate large volumes
  • Prescribe 2nd line medications in addition to 1st line medications if:
    • Incomplete cleanout or significant cleanout required
    • Already on a 1st line medication, but symptoms persisting
  • Treatment length
    • Continue on medication(s) until PCP follow-up
    • Maintenance treatment for at least 2 mos
    • All constipation symptoms should be resolved for at least 1 mo before stopping treatment
    • Decrease treatment gradually
Duration Medications
1st Line PO
  • Prescribe for 1 mo
  • Should continue for at least 2 mos
  • Polyethylene Glycol
    • 10-20 kg: 1/2 cap (8.5 g) once a day, dilute in 4 oz of water or juice
    • > 20 kg: 1 cap (17 g) once a day, dilute in 8 oz of water or juice
    • Titrate to effect
  • or
  • Lactulose
    • 1.5-3 mL/kg/day (1-2 g/kg/day)
    • Divided once or twice daily
    • Max: 60 mL/day
2nd Line PO
  • Prescribe for 2 wks
  • Do not continue unless instructed to at follow-up
  • All options may cause cramping
  • Senna
    Also available as chocolate or gummies
    Age Tablet
    1 tablet = 8.6 mg
    Liquid
    5 mL = 8.8 mg
    2-5 yrs 4.3 mg (1/2 tablet) daily 2.5 to 3.75 mL
    4.4 to 6.6 mg daily
    6-11 yrs 8.6 mg (1 tablet) daily 5 to 7.5 mL
    8.8 to 13.2 mg daily
    ≥ 12 yrs 17.2 mg (2 tablets) daily 10 to 15 mL
    17.6 to 26.4 mg daily
  • or
  • Magnesium hydroxide 400 mg/5 mL
    Caution with renal impairment due to toxicity from accumulation
    2-5 yrs 5-15 mL/day (0.4-1.2 g/day)
    Once or divided
    6-11 yrs 15-30 mL/day (1.2-2.4 g/day)
    Once or divided
    12-18 yrs 30-60 mL/day (2.4-4.8 g/day)
    Once or divided
  • or
  • Bisacodyl
    3-11 yrs 5 mg daily
    ≥ 12 yrs 5-15 mg daily

 

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