This document provides guidance on gut decontamination methods for poisoned patients, including ipecac, gastric lavage, activated charcoal, and whole bowel irrigation. It recommends that ipecac and gastric lavage should rarely be used. Activated charcoal is most effective if administered within one hour of ingestion for known poisons that can be bound by charcoal. Whole bowel irrigation may be useful for sustained-release preparations or potentially toxic heavy metal ingestions if started within 4 hours. Each method has specific guidelines around dosage, timing, and contraindications.

1. Toxicology Gut Decontamination Current Position Statements & Recommendations Dr.mohamad Shaikhani.

2. Gut Decontamination Ipecac Gastric Lavage Activated Charcoal Whole Bowel Irrigation

3. 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

4. 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)

5. 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

6. 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)

7. Gastric Lavage Lavage is rarely recommended anymore Differs from gastric aspiration At 30 minutes post ingestion < 40% of ingested substance is removed

8. 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

9. 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

10. No data to support or exclude its use after one hour post ingestion Recommended dose of 1g/kg Don’t need sorbitol

11. Contraindiations unprotected airway GI tract not intact acids/alkalis hydrocarbons iron ethanol, isopropyl alcohol lithium salts

12. Multiple Dose Charcoal Poisons with long half lives and/or entero-hepatic recirculation carbamazepine dapsone paraquat phenobarbital quinine theophylline

13. Do not use charcoal with sorbitol dose: 0.125 g/kg/hr up to 12.5 g/hr

14. 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

15. 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

16. 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

17. Contraindications: bowel perforation/obstruction GI hemorrhage ileus unprotected AW hemodynamic instability intractable vomiting

18. 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