GI regimen in ICU

Q: Polyethylene glycol (PEG), lactulose, and sorbitol are? (select one)

A) Hyper-osmolar laxatives

B) Hypo-osmolar laxatives 

Answer: A

PEG, lactulose and sorbitol are frequently used in ICU for gastrointestinal regimen protocols, particularly when narcotics are in use. They works via their hyperosmolar composition. PEG has the advantage that it does not cause gas or bloating.

Psyllium, methylcellulose, and calcium polycarbophil are bulk forming laxatives due their fiber makeup. 

Magnesium hydroxide (Milk of Magnesia) and magnesium citrate are called saline laxatives and worked more like hyperosmolar laxatives.

Senna  and bisacodyl are stimulants.

#GI

References:

1. Paré P, Fedorak RN. Systematic review of stimulant and nonstimulant laxatives for the treatment of functional constipation. Can J Gastroenterol Hepatol. 2014 Nov;28(10):549-57. doi: 10.1155/2014/631740. PMID: 25390617; PMCID: PMC4234355.

2. Ford AC, Suares NC. Effect of laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and meta-analysis. Gut. 2011 Feb;60(2):209-18. doi: 10.1136/gut.2010.227132. PMID: 21205879.