Algorithm for Treating Constipation in Hospitalized Patients

1. Start with miralax daily, uptitrate to desired BM, consider addition of senna as needed/if on opioids

2. Give magnesium citrate/suppository

If ESRD/cirrhosis: choose lactulose instead of milk of magnesia

If neutropenic, no enemas disimpaction

3. Give an enema including tap water, smog, or soap suds w/ oral laxative (avoid fleet enema with advanced renal disease)

4. Manual disimpaction



Dr. Ann Marie Kumfer @AnnKumfer



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