This handout is for small bowel obstruction. Your care team identified this based on: colicky abdominal pain + distension (wses bologna 2017).
Other reasons your team may use this plan: vomiting (bilious/feculent) + obstipation (wses bologna 2017); ct/xr showing dilated small bowel + transition point (acr appropriateness criteria 2020); tender / irreducible hernia (east 2012).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| normal_saline_or_LR | 1-2 L IV bolus then maintenance 75-125 mL/h | IV | continuous | Aggressive volume resuscitation; correct hypovolemia and emesis-related contraction alkalosis (WSES Bologna 2017; EAST 2012) |
| potassium_chloride | 20-40 mEq IV/PO per dose; titrate to K 4.0 | IV/PO | PRN | Replenish K+; check Mg simultaneously (WSES Bologna 2017) |
| ondansetron | 4-8 mg IV q6h PRN | IV | PRN | Symptom control; alternative metoclopramide avoided in mechanical obstruction (WSES Bologna 2017; NICE 2024) |
| hydromorphone | 0.5-1 mg IV q3-4h PRN | IV | PRN | Pain control; lower dose to avoid worsening ileus (EAST 2012) |
Plan: Small bowel obstruction — NOM with NGT decompression vs emergent OR (WSES Bologna 2017 + ACR 2020 + Abbas/Branco)
Call 911 or go to the nearest emergency room right away if you have:
Surgery consult on admission, post-op diet advancement, discharge criteria for NOM, outpatient follow-up 2 weeks, recurrence education (WSES Bologna 2017; NICE 2024)
Guideline: WSES 2017 Bologna ASBO Guidelines + EAST 2012 SBO PMG + ACR Appropriateness Criteria 2020 + Branco 2010 / Abbas 2024 (water-soluble contrast meta-analyses) + Zielinski 2017 (CT predictors of surgery) + SnapSBO 2025