Reversal of Opioid-Induced Gastric Dysfunction in a Critically Ill Burn Patient After Methylnaltrexone

In Brief Peripheral-acting mu opiate receptor antagonists have been extensively studied for the treatment of opiate-induced constipation in advanced illness for the prophylaxis of postoperative ileus. We document the first intensive care patient to receive methylnaltrexone in an attempt to facilitate enteral nutrition. Gastric residuals markedly decreased and enteral feeding increased after administration of IV methylnaltrexone. The patient's ileus resolved coincident with the first injection. IMPLICATIONS: We report the use of IV methylnaltrexone to facilitate feeding in a critically ill burn patient. After injection of the peripheral opiate antagonist, the patient's gastric residuals markedly decreased and the enteral feeding markedly increased.