Generally, the bowel prep consists of clear liquids 1-2 days prior to surgery and the following:

1. Rectal exam with disimpaction if necessary.
2. Golytely – Administer the afternoon or evening before the operation.
3. Patients < 40 kg - give 25 cc/kg/hr
4. Patients > 40 kg – give 1 liter/hr (Repeat until rectal effluents are clear for a maximum of five hours. Small children will need a NG tube to take sufficient volumes of Golytely. If the child has a mucus fistula, administer 100 cc NS irrigations through the fistula until clear.)
5. Normal saline enemas until clear – usually 10cc/kg. Approximate volumes shown below:
6. PO Antibiotics a. Neomycin sulfate 25 mg/kg/dose given 12,11 & 6 hrs preop, and b. Erythromycin base 25 mg/kg/dose given 12,11 & 6 hrs preop.
7. D5 1/2 NS with 20 mEq kcl/l at 150% of maintenance
8. STAT electrolytes at 6:00 pm on night before OR & STAT at 6:00 am on day of OR.

Patients are frequently placed on D5LR on the day of surgery (especially abdominal cases) at 1 to 1-1/2 maintenance. IV fluids need to be changed over on post-op day 1 to D51/2NS with 20 mEq KCL/L and rates decreased to maintenance (assuming urine output is adequate). Please be sure that whatever fluid you give, that it has DEXTROSE. If a patient needs a bolus, LR or NS is used at 10-20 cc/kg. Maintenance IVF: We use the 4/2/1 rule. 4 cc/kg for first 10 kg, then 2 cc/kg for 10-20 kg, then 1 cc/kg over 20 kg. So a 14 kg child’s maintenance fluids would be 48 cc/hr. Monitor urine output closely.