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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.
Intrahepatic Cholestasis of Pregnancy
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Activated charcoal. Activated charcoal is a highly porous carbon compound. It is widely used to treat acute poisoning following oral ingestion, where it binds to the toxin and prevents its absorption from the stomach and intestine. It can effectively adsorb bile salts in vitro. Safety: FDA class C. Compared to no treatment, the reduction in bile salts was greater with charcoal, but there was no difference in pruritus or fetal/neonatal outcomes in a very small RCT [22].
Paediatric clinical pharmacology
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Activated charcoal is effective in the treatment of poisoning with a number of toxins; however, routine use in the treatment of poisoning is inappropriate [9]. Charcoal is activated by heating in a stream of gas at high temperature. Activation generates small particles with a highly developed internal pore structure, increasing the surface area available for absorption of toxins and generating reactive carbon moieties able to bind a variety of toxins. Activated charcoal is most efficacious when administered within 1 hour of toxin ingestion. Substances for which treatment with activated charcoal is ineffective are listed in Table 1.
Foxglove poisoning: diagnostic and therapeutic differences with medicinal digitalis glycosides overdose
Published in Acta Clinica Belgica, 2022
Koen R. Maes, Pieter Depuydt, Joris Vermassen, Peter De Paepe, Walter Buylaert, Cathelijne Lyphout
Medicinal and vegetal cardiac glycoside poisoning produce similar symptoms and toxicity, but show important diagnostic and therapeutic differences.Activated charcoal should be considered a soon as possible (preferably within two hours, but also after expiration of this time). Multiple dose activated charcoal (MDAC) is recommended in order to interrupt intestinal absorption and enterohepatic cycling.Digoxin assays exhibit variable cross reaction with other vegetal cardiac glycosides rendering them unuseful to estimate the ingested amount, but may be used qualitatively.Digoxin-specific Fab fragments remain the most effective measure to reduce life-threatening arrhythmias and mortality, though the optimal dosage in vegetal intoxications remains unclear.Digoxin assays have no place in follow-up of the antidotal effect of Fab-fragments.
Toxicoepidemiology and predictors of death in 2,4-dinitrophenol (DNP) toxicity
Published in Clinical Toxicology, 2021
A. J. Potts, N. J. Bowman, D. L. Seger, S. H. L. Thomas
There is no specific antidote for DNP poisoning [9,10] and no specific evidence to demonstrate the effectiveness of different approaches, so the management of DNP poisoning remains largely supportive. In the absence of contraindications, the use of oral activated charcoal should be considered if the patient presents soon after ingestion. Use of sedation (e.g., benzodiazepines) for aggressive control of agitation is rational as muscular activity increases heat generation. Cooling measures should be instituted early in those developing pyrexia, starting with simple non-invasive methods such as mist and fan techniques, external ice packs or other external cooling devices, progressing to invasive methods such as cold fluid lavage or intravascular cooling methods if temperature continues to increase. There is no rigorous evidence of efficacy for dantrolene in DNP poisoning and its role in management has been contested, [7] although successful use in those with extreme pyrexia has been reported [11]. Fluid loss may occur due to gastrointestinal disturbances or pyrexia and adequate replacement is important. This also requires careful monitoring of electrolytes to decrease the risk of hyperkalaemia. Intubation may be difficult in critically ill patients with advanced DNP toxicity as muscular spasms and jaw clenching can occur; early intubation and ventilation is therefore appropriate for the deteriorating patient with DNP toxicity.
Stoned on spices: a mini-review of three commonly abused household spices
Published in Clinical Toxicology, 2021
Kelly Johnson-Arbor, Susan Smolinske
The diagnosis of nutmeg intoxication is clinical; laboratory assays for nutmeg or its constituents are not readily available. Symptomatic and supportive care is sufficient for a majority of nutmeg exposures; patients with dehydration, prolonged hallucinations, or altered mentation may require hospitalization and pharmacologic treatment with anxiolytics and intravenous fluids. Gastrointestinal decontamination with activated charcoal may be beneficial for hospitalized patients who present soon after ingestion and who are at low risk for aspiration [17]. Two fatalities related to nutmeg exposure have been reported. In the first, an 8-year-old boy died 20 h after the ingestion of 2 nutmeg seeds [4]. The details surrounding this fatality are unclear as the report included very limited clinical information; it is unknown whether this outcome was affected by additional ingestions or underlying medical conditions. The second case involved a 55-year-old woman who died under unclear circumstances; postmortem toxicological examination revealed the presence of elevated concentrations of flunitrazepam and myristicin, and her stomach contents had an odor consistent with nutmeg [18].