Rectal Fluid Administration - anyone have experience?

This is not published but Deployment Medicine International did some studies on how much fluid can be administered and what the best method for infusion.

The body of an average male weighing 70kg can absorb 150ml per hour rectally. The best method is to place a tube about the size of the patient's pinky 20cm into the rectum. Infuse 750ml to 1L of normal saline. Top up that fluid with 150ml each hour.

Have the patient lay on his right side for easer maintenance.

This is not rehydration. This is only a stop gap measure whilst the patient actually rehydrates orally. In order to rehydrate a causality you will need a lot more than 150ml per hour.

Several of our instructors have taught for Dr. Hagmann and DMI. He does some excellent research and experiments that benefit the deployed medic.

PM me if you want to chat about this CoolMoose.
 
Is it worth it? At that level of intake and considering its awkward for the patient to drink whilst lying on their side (noting that people who are dehydrated seriously often also have problems keeping liquid down), would it be more effective to have the person sitting up sipping measured amounts? Or is it that the fluid taken orally will take too long to get around the small intestine before being absorbed by the large intestine?
 
littlewoman said:
Is it worth it? At that level of intake and considering its awkward for the patient to drink whilst lying on their side (noting that people who are dehydrated seriously often also have problems keeping liquid down), would it be more effective to have the person sitting up sipping measured amounts? Or is it that the fluid taken orally will take too long to get around the small intestine before being absorbed by the large intestine?
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Good questions.

The only reason to suggest that anyone try rectal rehydration is as a last ditch effort. All other means for rehydration have failed. Therefore, no IVs, no IOs, no PO, and no dermoclysis.

Look, the bottom line is this: 150ml per hour is not enough but it will keep someone alive longer than not getting any fluids in.

Your questions about positioning are very important. In my experience, having someone with a full large intestine trying to sit up will not be the most comfortable. Sure it is easier to have someone sipping orally whilst sitting up.

If they can sip, then they don't need rectal rehydration.

You can absorb 250ml every 15 minutes orally. That is the maximum amount that you can absorb. If you take more than that they you will just wee it out. But this is still a great way to rehydrate. You can get 1L per hour into the casualty this way.

If you want to talk about benefits to the casualty then sure, 1150ml per hour is better than 1000ml an hour if you use both orally and rectally to hydrate. But that 15% difference is not really enough motivation to get someone to take one up the back passage if they can actually drink.


When you choose to use rectal rehydration you don't have a casualty who will refuse a 6mm pipe up the bum. They are too far gone to even care. That should be your decision making process. If they successfully fight your attempts to rehydrate rectally then they can bloody well take oral rehydration.

There is also the problem with social barriers. In some countries you will never touch a female let alone rehydrate them in this manor. Their family will be quite happy to have her die without this procedure. It is a touchy subject.


Just my two pence.
 
Rectal Fluid admin was used heavily in the Falklands War,due to hypothermia of the patients. I believe Cmdr Rick Jolly wrote a couple of papers post conflict, these may not show up in a literature search as they are quite old, maybe worth checking the RAMC journal or alike.

Hope that helps.

Russ
 
Would it not be better to position the casualty on their left to promote flow into the sigmoid colon - as per PR medication and enema?

Dermoclysis? Every day's a learning day - more great work mate.
 
Good point Adam. This has been debated ad nauseum.

You are correct that flow is better laying on the left but that also means that flow is easier to come out as it is to go in.

So, do you lay them on their left for better flow or on their right to restrict the flow.

One thought is that it is quite easy to get the flow going in with enough pressure. We want that fluid to stay in as easily as possible. Therefore a slight trendelenburg position with the casualty on the right to make the fluid stay in or on their left to make it easier for the medic to infuse.

It is six of one and a half dozen of the other. I am open to a dialogue to discuss this.


Thanks for the link to dermoclysis. Now that we have moved out of Ireland perhaps we can start demonstrating that on our remote courses. Things are a little more relaxed here in Malta.

Still, I doubt we will have many volunteers for the proctoclysis........
 
That's interesting - I'm not in a position to debate it but I find it interesting that in so many instances we always do things simply because we have always done them that way.

It would be great to meet up in Malta and when we do I'll be wearing two pairs of canvas pants with buttocks clenched ;)
 
That is fascinating. No, I have not come across that study before. Thanks for that.

Impressive to be able to give 3L of fluid over 48 hours. Saved a life. This should be standard curriculum for all EMT and Paramedic students including the HCPC Paramedics.

This is what separates the men from the boys. This is the ability to think outside of the box.
 
Not sure if this is appropriate, but during my days as an Army Combat Medic, one of our guys found our mascot dog "Max" hyperventilating and unable to move, semi-conscious, under hot and dry weather conditions.
Our PA determined that she was suffering from dehydration and subsequent hyperthermia, so we tried to administer an IV on her.
We couldn't find a good vein to set up the IV so we eventually administered rectally.
"Max" fully recovered after a few hours; that was back in 2000; she recently passed away a few months ago.

Works for dehydration and heat-related injuries; no experience on its application and feasibility for shock treatment.
 
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