In a disaster, it’s possible that you might encounter a person in shock who is desperately in need of fluids. IV hydration is certainly the best method of delivery in these cases, but Normal Saline and others are prescription products. As such, they are difficult to stockpile in an austere setting.
Rectal rehydration, also called Proctoclysis, may be an alternative in situations where IV therapy is unavailable. The large intestine functions to absorb water, electrolytes, and vitamins (but not nutrients), leaving solid waste. It stands to reason that, if the colon can absorb fluid introduced from “above”, it should be able to absorb it from “below”.
In the first decade of the 20th century, John Murphy, a Wisconsin Surgeon, introduced a drip method of introducing salt solutions via the rectum. Used in the hospital units in World War I, proctoclysis received acceptance as another tool in the medical woodshed. As intravenous fluid administration became more advanced, use of the method diminished.
I knew little about proctoclysis as it is rarely used in modern medicine. The difficulty that the average person would have obtaining IV fluids in a survival situation, however, made it clear that an alternative fluid delivery system was needed for those unable to be orally rehydrated. Indeed, it’s the lack of availability of many medical items in times of trouble that first led me to write about “fish antibiotics” as a survival option years ago.
During my research, I found animal studies in the Emergency Medicine Journal. In one study, rabbits were drained of blood until they were severely depleted. A tube was then inserted into their rectums and fluids administered. This led to improvement of the vital signs used to monitor shock.
Another study in 1998 used the procedure with tap water or saline solution in 78 terminally ill cancer patients with success. In the Wilderness and Environmental Medicine journal, a single case of shock at a remote high-altitude location was treated with proctoclysis; it improved the patient’s status enough to allow evacuation.
The benefit of rectal rehydration is the fact that sterilized water or oral rehydration solutions may be used effectivel via the rectum to improve fluid status. This provides an inexpensive and readily available avenue when intravenous therapy isn’t possible.
To perform proctocylsis on a patient, you’ll need the following:
• Sterilized Water/Normal Saline/Oral Rehydration Salt solution
• #22 Naso-Gastric Tube or #14 Foley Urinary Catheter with 10 ml. syringe
• A reservoir container for the fluids
• Tubing to connect the reservoir container to the NG or Foley Catheter
• Gloves (wash your hands!) and lubricant
• A way to monitor the rate of infusion (In the 1998 study involving humans, the fluid was infused at a rate of 250 cc/hour)
• A way to secure the tube in place
• A “stand” to place the reservoir at a level higher than the patient
• Equipment to monitor vital signs (blood pressure, pulse, respiration rate)
From my perspective, points to consider include:
• The fluids used should be warmed to normal body temperature to prevent hypothermia (excessive lowering of body temperature).
• The patient should be placed on their left side; this might decrease drainage.
• If the patient is conscious, be sure to discuss the method of procedure and its purpose beforehand.
• Closely monitor vital signs throughout the procedure.
• The naso-gastric tube can be inserted further into the large intestine than the Foley catheter, which might result in improved absorption. The Foley catheter, however, will prevent much of the leakage that you may find with the NG tube (Foleys have an inflatable balloon that can act as a “plug”). In the cases cited, the NG was inserted about 15 inches, while the Foley was inserted about 5-8 inches and then pulled back gently until the balloon met resistance.
• Excessive pressure on the rectum from the Foley balloon could cause trauma.
• Be prepared to deal with drainage, which can be messy.
• An enema effect may be observed, especially if high volumes of fluids are given too quickly. If this is observed, stop proctoclysis (the patient is losing fluids).
• Rectal rehydration should be avoided in cases of diarrhea, as a hyperactive bowel may not adequately absorb liquids.
• The procedure can be uncomfortable, and is not a “feeding” method. There’s evidence that it’s been used as torture throughout history.
It’s important to know that you should never try this or any other medical procedure if there is modern medical help available. The practice of medicine is illegal and punishable by law, so keep this method of rehydration in reserve only for post-apocalyptic, austere, or remote settings.
Joe Alton, M.D.
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