Toxicology Gut Decontam.

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Medical college lectures: toxicology/poisoning 5nd year.

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Toxicology Gut Decontam.

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

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