Toxicology Gut Decontam.
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Toxicology Gut Decontam.

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Medical college lectures: toxicology/poisoning 5nd year.

Medical college lectures: toxicology/poisoning 5nd year.

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    Toxicology Gut Decontam. Toxicology Gut Decontam. Presentation Transcript

    • Toxicology Gut Decontamination Current Position Statements & Recommendations Dr.mohamad Shaikhani.
    • Gut Decontamination
      • Ipecac
      • Gastric Lavage
      • Activated Charcoal
      • Whole Bowel Irrigation
    • Ipecac
      • Should not be administered routinely in the poisoned patient
      • Drug amount removed highly variable & decreases with time
      • Routine administration in the ER should be abandoned
      • may delay the administration & effectiveness of charcoal, oral antidotes, & whole bowel irrigation
      • Can mask signs of toxicity
      • Most useful when ingestion of unknown or potentially toxic amount of substance if patient not close to the ED
      • Only beneficial within 60 minutes (solids) , 30 minutes (liquids)
      • Contraindications:
        • Compromised AW reflexes
        • Drugs potentially causing CNS depression or seizures (INH, TCA)
        • Drugs where increased vagal tone not desirable (digoxin, CCB, BB)
        • Dydrocarbon ingestion
        • Ingestion of strong alkali or acid
        • Medical conditions further compromised by emesis
      • Dose:
        • 6 to 12 months: 5 to 10 cc (with water)
        • 1 to 12 years: 15 cc (with water)
        • 12 years and older: 15 to 30 cc (with water)
    • Gastric Lavage
      • Lavage is rarely recommended anymore
      • Differs from gastric aspiration
      • At 30 minutes post ingestion < 40% of ingested substance is removed
      • Complications
        • aspiration
        • laryngospasm hypoxia and hypercapnia
        • mechanical injury
        • fluid and electrolyte imbalance
        • increased amount of toxin placed into small intestine
      • risks considered to outweigh the benefits
    • Activated Charcoal
      • Not routinely administered in poisoned patients but will be used most often
      • Greatest benefit within one hour post ingestion
      • Administered if ingested potentially toxic amount of poison known to be bound by charcoal
      • No data to support or exclude its use after one hour post ingestion
      • Recommended dose of 1g/kg
      • Don’t need sorbitol
      • Contraindiations
        • unprotected airway
        • GI tract not intact
        • acids/alkalis
        • hydrocarbons
        • iron
        • ethanol, isopropyl alcohol
        • lithium
        • salts
    • Multiple Dose Charcoal
      • Poisons with long half lives and/or entero-hepatic recirculation
        • carbamazepine
        • dapsone
        • paraquat
        • phenobarbital
        • quinine
        • theophylline
      • Do not use charcoal with sorbitol
      • dose:
        • 0.125 g/kg/hr up to 12.5 g/hr
    • Whole Bowel Irrigation
      • Should not be administered routinely in the poisoned patient
      • potentially toxic ingestions of SR or EC drugs
      • potentially toxic ingestions of:
        • iron, lead, zinc
      • Cocaine body packers/stuffers
      • Optimal to start within 4 hours
      • GoLytely or other polyethylene glycol electrolyte solution
      • use N/G tube --- patients won’t drink enough
      • may give A/C prior
      • do not give MDC during. MDC after WBI
      • Adults:
        • 1000 cc/hr and increase to 2000cc/hr
      • Children ( 9 months and up):
        • 250 cc/hr and increase to 500 cc/hr
      • until rectal effluent is clear
      • Contraindications:
        • bowel perforation/obstruction
        • GI hemorrhage ileus
        • unprotected AW
        • hemodynamic instability
        • intractable vomiting
    • Summary
      • Ipecac
        • Rarely used in the ED
        • Situation specific
      • Lavage
        • Forget about it
      • Charcoal
        • Most effective
        • Administer within one hour if possible
      • WBI
        • Effective with appropriate poisons