Neostigmine for the treatment of acute colonic pseudo-obstruction (ACPO) in pediatric hematologic malignancies

Abstract

BackgroundAcute colonic pseudo-obstruction (ACPO) refers to dilatation of the colon and decreased bowel motility without evidence of mechanical obstruction. Neostigmine, an acetylcholinesterase inhibitor, has been used in patients in whom supportive therapy failed to resolve ACPO. Here, we report the results of administering neostigmine to treat ACPO in children with hematologic malignancies.MethodsBetween September 2005 and December 2009, 10 patients (8 male and 2 female) were diagnosed with ACPO at the Department of Pediatrics, Catholic University of Korea. Diagnosis of ACPO was based on typical clinical features as well as colonic dilatation found on abdominal CT imaging. Neostigmine was administered subcutaneously at a dosage of 0.01 mg/kg/dose (maximum 0.5 mg) twice daily for a maximum of 5 total doses. ACPO was determined to be responsive to neostigmine if the patient showed both stool passage and improvement of clinical symptoms.ResultsThe study group included 8 acute lymphoblastic leukemia patients, 1 patient with malignant lymphoma, and 1 patient with juvenile myelomonocytic leukemia. The median age at ACPO diagnosis was 8.5 years (range, 3-14). Overall, 8 patients (80%) showed therapeutic response to neostigmine at a median of 29 hours after the initial administration (range, 1-70). Two patients (20%) showed side effects of grade 2 or above, but none complained of cardiovascular symptoms that required treatment.ConclusionIn this study, ACPO was diagnosed most often in late-childhood ALL patients. Subcutaneous neostigmine can be used to effectively treat ACPO diagnosed in children with hematologic malignancies without major cardiovascular complications.

Drugs Acting on the Gut: Prokinetics, Antispasmodics, Laxatives

“…Its use as a promotility agent has not been well studied in pediatric patients. The fi rst reported case of successful treatment of a pediatric patient with ACPO was in a 4-year-old male with spastic quadriplegia who was 10 days postoperative for bilateral femoral varus derotational osteotomies and botulinum toxin injections of the gastrocnemius muscles [ 53 ] . Neostigmine was administered intravenously at a total dose of 0.05 mg/kg over 5 h [ 53 ] .…”

“…The fi rst reported case of successful treatment of a pediatric patient with ACPO was in a 4-year-old male with spastic quadriplegia who was 10 days postoperative for bilateral femoral varus derotational osteotomies and botulinum toxin injections of the gastrocnemius muscles [ 53 ] . Neostigmine was administered intravenously at a total dose of 0.05 mg/kg over 5 h [ 53 ] . In a group of 10 pediatric patients with hematologic malignancies who experienced ACPO, 8 responded to doses of neostigmine at 0.01 mg/kg/dose administered subcutaneously, given twice a day for no more than 5 doses [ 54 ] .…”

Drugs Acting on the Gut: Prokinetics, Antispasmodics, Laxatives

“…The fi rst reported case of successful treatment of a pediatric patient with ACPO was in a 4-yearold male with spastic quadriplegia who was 10 days postoperative for bilateral femoral varus derotational osteotomies and botulinum toxin injections of the gastrocnemius muscles [ 67 ]. Neostigmine was administered intravenously at a total dose of 0.05 mg/kg over 5 h [ 67 ]. In a group of ten pediatric patients with hematologic malignancies who experienced ACPO, eight responded to doses of neostigmine at 0.01 mg/kg/dose administered subcutaneously, given twice a day for no more than fi ve doses [ 68 ].…”

“…Its use as a promotility agent has not been well studied in pediatric patients. The fi rst reported case of successful treatment of a pediatric patient with ACPO was in a 4-yearold male with spastic quadriplegia who was 10 days postoperative for bilateral femoral varus derotational osteotomies and botulinum toxin injections of the gastrocnemius muscles [ 67 ]. Neostigmine was administered intravenously at a total dose of 0.05 mg/kg over 5 h [ 67 ].…”

Impact of educational intervention on conservative treatment of intestinal pseudoobstruction and paralytic ileus with neostigmine at Emergency Center of Clinical Center Kragujevac

“…Бради-кардија индукована неостигмином лечи се применом атропина у дози од 1,0 mg 18 . Неки аутори сматрају да би неостигмин требало применити у виду интравенске инфузије то-ком 24 часа или у виду субкутане инјекције зато што оваква примена носи мањи ризик од појаве нежељених дејстава 19,20 . Апсолутне контраиндикације за примену неостигмина су постојање механичке опстру-кције интестиналног и уринарног тракта, по-стојање перфорације и исхемије црева, труд-ноћа као и позната хиперсензитивност на лек 7 .…”