Download BOWEL OBSTRUCTION: octreotide,somatostatin, scopolamine

BOWEL OBSTRUCTION: octreotide,somatostatin, scopolamine, Glycopyrrolate
, Robinul,
Description:
Often difficult to diagnose, accumulation and increased secretions contribute to
abdominal pain and distension, vomiting and prolonged constipation. Vomiting
develops early and in large amounts when the level of obstruction is high.
Intermittent borborygmi and visible peristalsis may occur. Often with a severe
colicky pain that worsens as abdomen bloats.
Intraluminal fluid is primarily derived from endogenous secretion. The average
person's exogenous fluid intake is only approximately 2 liters per day. Average
intestinal fluid secretion into the lumen is nearly 8 liters per day from gastric and
small intestinal mucosa
Management:
Regardless of cause -Leads to pain, nausea, vomiting
Traditionally led to nasogastric tube and drainage BUT
Decompression of the gas and fluid build-up in the intestine is the primary goal of
nasogastric tube placement.
The use of corticosteroids has been recommended to decrease the inflammatory
response and resultant edema and relieve nausea through central and peripheral
antiemetic effects. I
Antispasmodic agents (hyosine butylbromide 60-120 mg /24 hours by sc
infusion) can be added for patients with marked colicky pain.
Commercially available combination preparations containing atropine,
scopolamine, hyoscyamine, and phenobarbital (Donnatal, for example) are also
available. The quaternary ammonium compounds that are clinically useful are
ipratroprium and glycopyrrolate.Glycopyrrolate (Robinul, 0.1 -0.2mg qid
maximum, comes in a one ml ampul of 0.2 mg /ml).
Octreotide is generally well tolerated with the most common side effect being dry
mouth amenable to ice chips and moist troches. 100 mcg q8h up to 25mcg/hr
continuous infusion.
Tips:
(1) intraluminal obstruction (e.g., by tumor mass); (2) direct infiltration of the
bowel wall (e.g., colon carcinoma); (3) external compression of the lumen; (4)
carcinomatosis causing dysmotility (e.g., ovarian carcinoma); and (5) intraabdominal adhesions (e.g., from postoperative changes)
Antispasmodic agents (hyosine butylbromide 60-120 mg /24 hours by sc
infusion)
Atropine (a racemic mixture of dextro- and levo-hyoscyamine) is considered the
prototype antimuscarinic. Commercially available combination preparations
containing atropine, scopolamine, hyoscyamine, and phenobarbital (Donnatal, for
example) are also available. The quaternary ammonium compounds that are
clinically useful are ipratroprium and glycopyrrolate.Glycopyrrolate (Robinul, 0.1 0.2mg qid maximum, comes in a one ml ampul of 0.2 mg /ml).
Octreotide is generally well tolerated with the most common side effect being dry
mouth amenable to ice chips and moist troches. 100 mcg q8h up to 25mcg/hr
continuous infusion.
Dexamethasone had been used to decrease peritumor edema and imporve
intestinal transit, but its role in preventing a complete obstruction remains
undetermined.
References:
1. American Hospital Formulary Service: Drug Information: Octreotide Acetate.
Bethesda, MD, AHFS, 1995, p 2609
2. Fallon MT: The physiology of somatostatin and its synthetic analog, octreotide.
European Journal of Palliative Care 1:20-22, 1994
3. Lamberts SWJ, van der Lely A-J, de Herder WW, et al: Drug therapy:
Octreotide. N Engl J Med 334:246-254, 1996 Citation
4. Mangili G, Franchi M, Mariani A, et al: Octreotide in the management of bowel
obstruction in terminal ovarian cancer. Gynecol Oncol 61:345-348, 1996 Abstract
5. Mercadante S: Tolerability of continuous subcutaneous octreotide used in
combination with other drugs. J Pallia Care 11:14-16, 1995
6. Mercadante S, Maddaloni S: Octreotide in the management of inoperable
gastrointestinal obstruction in terminal cancer patients. J Pain Symptom Manage
7:496-498, 1992 Citation
7. Mercadante S, Spoldi E, Caraceni A: Octreotide in relieving gastrointestinal
symptoms due to bowel obstruction. Palliat Med 7:295-299, 1993 Abstract
8. Petrelli N: Octreotide in chemotherapy related diarrhea [abstract 493]. ASCO
Proceedings, July 1992
9. Riley J, Fallon MT: Octreotide in terminal malignant obstruction of the
gastrointestinal tract. European Journal of Palliative Care 1:23-25, 1994
10. Mercadante, S Octreotide May Prevent Definitive Intestinal Obstruction
Journal of Pain and Symptom Management (1997); 13:352-355.
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Modification date: 8/5/2003 @ 21:13:39