In this section : Poisoning
Paracetamol
SSRI Poisoning
Aspirin
Digoxin Poisoning
Tricyclic Antidepressants
Opiates
Benzodiazepines
Gut Decontamination
Deliberate Self Harm
Gut Decontamination
Last updated 3rd December 2020
Last updated on 19th May 2014 by Calum Murray
Overview
- The routine use of any gut decontamination procedure is inappropriate as there is no clear evidence that they improve outcome and they may cause significant morbidity.
Syrup of Ipecacuanha
- There is no evidence that syrup of ipecacuanha reduces drug absorption significantly and it has side-effects which increase morbidity and make diagnosis more difficult. Avoid.
Gastric Lavage (Stomach Washout)
- Should be considered only if a patient has ingested a life-threatening amount of a toxic substance within 1 hour.
- Contraindications to lavage include: ingestion of hydrocarbons (risk of aspiration pneumonitis), ingestion of corrosives (risk of gut perforation and aspiration of corrosives into the lungs), and if the airway cannot be protected.
Activated Charcoal
- Due to its large surface area, activated charcoal effectively adsorbs many toxins. It should be given to all patients presenting within 1 hour of significant ingestion of a toxic substance that binds to charcoal.
- The dose is 50g PO, which can also be given via N-G tube if the patient will not swallow or has a low GCS, provided that the airway can be adequately protected.
- Agents not adsorbed by activated charcoal include:
- Boric acid
- Cyanide
- Ethanol
- Ethylene glycol
- Iron
- Lithium
- Malathion
- Methanol
- Petroleum distillates
- Strong acids and alkalis
- Although it may seem reasonable to assume that late administration of activated charcoal may be beneficial for sustained release preparations (SR) preparations there is no evidence to support this.
Multiple Dose Acivated Charcoal (MDAC)
- Multiple-dose activated charcoal increases elimination of digoxin, carbamazepine, dapsone, phenobarbital, quinine and theophylline though it has not yet been shown in a controlled study to reduce morbidity and mortality among poisoned patients.
- It involves administration of AC 50g every 4 hours until clinical improvement.