Gastrointestinal Decontamination

OVERVIEW

The role for digestive tract decontamination depends on:

1. severity of poisoning
2. time from ingestion
3. risk of intervention

ACTIVATED CHARCOAL

• 1g/kg
• usually given if patient presents within 1 hour of ingestion, but varies according to agent
• can reduce absorption of many drugs: aspirin, paracetamol, phenobarbitone, digoxin, carbamazepine, theophylline, phenytoin
• little value with: acids, alkalis, arsenic, bromide, cyanide, DDT, ethanol, ethylene glycol, heavy metals, hydrocarbons, iodide, iron, lithium, methanol (highly lipophilic drugs)
• repeat doses are not usually indicated unless ingestion of large amounts and SR preparations

INDUCED EMESIS

• ipecac
• no longer in use
• induces risk without any evidence of decreased absorption

GASTRIC LAVAGE

• perform early ( decreases absorption
• may be useful within 4 hours of large, lethal doses of drug
• associated with visceral damage and aspiration
• may be additionally beneficial if combined with activated charcoal
• don’t give with corrosive, caustic, acids or petroleum ingestion
• place patient semi-prone and head down -> large bore N/G -> aspirate stomach -> 1mL/kg of H2O at body temperature instilled and suctioned -> repeated until water is clear

WHOLE BOWEL IRRIGATION

• using polyethylene glycol (golytely)
• decreases absorption by decreasing transit time
• suitable for conscious patients who have ingested tablets that don’t bind well to charcoal and can be identified on a plan radiograph
• don’t use with charcoal
• 1-4 L/hr until patient passes clear fluid from bowel
• 20mL/kg/hr in paediatrics

ENDOSCOPY

• rare, toxic metals, body packer

SURGICAL REMOVAL

• rare, e.g. body packer with bowel obstruction

References and Links