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Poisoning
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Activated charcoal can be given orally or via a nasogastric tube to those who present within an hour of a potentially toxic ingestion. The large surface area and high adsorptive capacity of activated charcoal enable it to bind to and reduce gastrointestinal absorption of most toxins. Due to the risk of serious complications, gastric lavage is no longer routinely recommended. Whole bowel irrigation is given for slow-release preparations and for body packers; its use should be guided by a clinical toxicologist.
Paediatric clinical pharmacology
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Gastric lavage has a very limited role in the treatment of a small number of specific poisonings, where the procedure can be performed within 1 hour of ingestion [8]. There is no evidence that lavage improves outcome and the treatment itself carries significant risks. Gastric lavage is contraindicated if a corrosive substance or volatile hydrocarbon has been ingested. Adequate airway protection is essential in the presence of an altered level of consciousness.
Antiepileptic Drug Toxic Emergencies
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Despite wide use for approximately 30 years, little has been written concerning massive overdosages with ethosuximide (ESM) (1,57–58). This may reflect its primary use in children for petit mal epilepsy in contrast to other AEDs discussed above, which are employed for both adults and children with epilepsy. Most reports of “toxicity” due to excess drug describe ambulatory patients with levels at the high end or just above of the “therapeutic” range, rather than massive poisonings, as may be seen in suicide attempts (59,60). Clinical manifestations may include dizziness, ataxia, and sedation progressing to coma, and respiratory insufficiency. Treatment with gastric lavage and general medical supportive care should result in complete recovery (1).
Acute diquat poisoning resulting in toxic encephalopathy: a report of three cases
Published in Clinical Toxicology, 2022
Guangcai Yu, Tianzi Jian, Siqi Cui, Longke Shi, Baotian Kan, Xiangdong Jian
A 20-year-old previously healthy man ingested approximately 100 mL of diquat (20 g/100 mL). Gastric lavage and haemoperfusion were performed afterwards. On day 3, he displayed oliguria, agitation, convulsions, and respiratory failure; haemodialysis was performed, and he was put on mechanical ventilation was given. He was admitted to our department the next day. On admission, his heart rate was 111 beats/min, blood pressure was 145/79 mmHg. Coma, anuria, and abdominal distension were the main abnormal signs. Laboratory test results were as follows: creatinine, 882 μmol/L; urea, 37.4 mmol/L; potassium, 3.37 mmol/L; and sodium, 138 mmol/L. The pesticide ingested was confirmed as diquat by the sodium bicarbonate/dithionite test. His main therapeutic options were similar to case 1. On day 6, his urea was 38.6 mmol/L, creatinine was 989 μmol/L. His daily urine volume was 600 mL and increased gradually afterwards. On day 12, he was weaned from mechanical ventilation, but he was still semi-comatose. His brain CT showed a low density in the brainstem region. The next day, toxic encephalopathy was confirmed (Figure 2). After 18 days, he experienced cardiac arrest and died.
The usefulness of non-contrast abdominal computed tomography for detection of residual drugs in the stomach of patients with acute drug overdose
Published in Clinical Toxicology, 2019
Yong Sung Cha, Seung-Whan Cha, Sun Ju Kim, Yoon Seop Kim, Yoonsuk Lee, Hyun Kim
In early treatment of acute drug poisoning, inhibition of drug absorption and promotion of drug elimination are important aspects to be considered. The original position statement from the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists concluded that, although gastric lavage should not be performed routinely, it should be considered in cases of life-threatening poisoning when the patient reports to the hospital within 60 min [1]. In many cases, drug-poisoned patients may not arrive at the hospital within 60 min. A non-invasive technique that can detect residual life-threatening drugs in the stomach, in delayed presentation cases (more than 60 min after drug ingestion), may aid clinicians in treatment planning to minimize absorption and promote elimination of the remaining drugs. The various therapeutic methods that may be used include gastric lavage, whole bowel irrigation (WBI), or esophagogastroduodenoscopy (EGD), based on the characteristic of each drug [1–8].
Clinical presentation of type 1 and type 2 pyrethroid poisoning in humans
Published in Clinical Toxicology, 2022
Manna Sera Jacob, Ramya Iyyadurai, Arun Jose, Jude Joseph Fleming, Grace Rebekah, Anand Zachariah, Samuel George Hansdak, Reginald Alex, Vignesh Kumar Chandiraseharan, Audrin Lenin, John Victor Peter
Gastric lavage was done for 24 out of 59 patients at local hospitals prior to referral to our centre. After arrival, 9 patients received gastric lavage in our study centre at a median time of 4 h; 5 patients received one dose of activated charcoal in the ED at a median time of 3 h prior to identification of the compound and this was discontinued once the compound was identified as a pyrethroid. Out of the 22 patients with quantified serum pyrethroid levels, 8 patients had received prior gastric lavage. There was no effect (p = 0.63) of prior gastric lavage on serum pyrethroid levels (Figure 2). On univariate logistic regression analysis (Table 4), prior gastric lavage was not associated (p = 0.67) with a reduction in the severity of toxicity at presentation.