Gut Decontamination, as part of the Medical Toxicology MRCP 1 course. These are slideshows only. The demonstration with video presentation and explanation that goes along with these slides, as well as free example exam questions and the paid full e-lecture can be viewed at https://www.123doc.com/electures/medical-toxicology/

1. Medical Toxicology
David Wood

2. Gut decontamination

3. Gastric Lavage
• Little evidence that its use is beneficial
• Possible benefit in life-threatening overdoses
presenting early
• Risks of procedure:
– Aspiration if unprotected airway
– Gut perforation during tube insertion
– Hypoxia increasing risk of cardiac arrhythmias

4. Activated Charcoal
• Good evidence for its use in patients presenting within
1 hour of ingestion of most drugs / toxins
• Dose is 50 grams in adults
• Adverse effects of activated charcoals
– Poor compliance
– Aspiration risk is not clear
– Adsorbs other drugs given orally

5. Multi-dose activated charcoals
• Evidence that it is useful is these overdoses:
• Modified or slow releasing preparations
• Salicylates
• Drugs with entero-hepatic circulation
• Dose is 50grams every 3 to 4 hours
• Adverse effect:
• Constipation
• Bowel obstruction

6. Whole Bowel irrigation
• Ensure the GI tract is clear of all ingested agents
• Current suggested indications:
– Toxins not absorbed by activated charcoals
– Modified or slow releasing preparation
– Body packers / body stuffers
• Dose:
– Polyethylene glycol 1.5 to 2 L/hr until rectal effluent is
clear

7. A 28 year old body packer is bought to the
ED by customs and excise. He has ingested
up to 40 packages of cocaine. His heart
rate, blood pressure and temperature are
normal and there are no signs of cocaine
toxicity.

8. What is the appropriate management?

9. What is the appropriate management?
Answer A
Upper GI endoscopy and package retrieval
Package retrieval by endoscopy carries the package rupture

10. What is the appropriate management?
Answer B
Whole bowel irrigation
• Whole bowel irrigation will ensure that the whole of GI tract is clear
of ingested packages
• Although the patient may be aware the number ingested the
packages are often made up of numerous smaller packages

11. What is the appropriate management?
Answer C
Activated charcoal
The package will be wrapped in plastic or similar therefore the
charcoal will not be able to absorb the drug

12. What is the appropriate management?
Answer D
Urgent Laparotomy
Urgent laparotomy is required in people with evidence of
package rupture / leakage and appropriate toxicity

13. What is the appropriate management?
Answer E
Observation only
Observation alone is not appropriate as it is not possible to
determine when all the packages have been passed