Tox Tips

Summer Florida Poison Information Center Network 2006 Jacksonville · Miami · Tampa Best Practices in Gastric Decontamination after a Poisoning

1. Discontinue hypoxia, dysrhythmias and a higher preva-

Full text articles use of Syrup l e n c e o f I C U Studies cited in of Ipecac. admission than with this newsletter other decontamination are in Position Popularity of Ipecac methods. When Statements on has diminished greatly activated charcoal is GI Decontamination found from its peak use in at www.clintox.org. These given via the lavage 15% of all US poison 2. Discontinue practice guidelines on tube, complications center cases in 1985 Syrup of Ipecac, Acti- routine use include aspiration of vated Charcoal, Cathar- to less than 0.7% of 2 charcoal and airway tics, Lavage and Whole cases in 2001 . There of lavage. obstruction. Bowel Irrigation are based is no clinical evidence Gastric lavage per- on studies reviewed by toxicology experts from that it improves the formed after one hour 3. Use American Academy of outcome of poisoned of the ingestion is po- Activated Clinical Toxicology. patients and its routine tentially more harmful 1. Krenzelok, EP et al. J use in ER’s should be than beneficial. Clini- Charcoal Tox Clin Tox. Vol. 42(2). abandoned. Two cal studies described only when pp 133-143. New York: important reasons are in the Position State- Marcel Dekker, Inc., 2004. that post-Ipecac ments show that the needed. 2. www.aapcc.org, Ameri- v o m i t i n g m a s k s amount of gastric Activated charcoal is can Association of Poison potential symptoms contents removed via most effective in re- Control Centers: Finalized and delays the admini- lavage diminishes ducing absorption of Patient Management Guideline on the Use of stration of more effec- significantly over time. drugs and toxins when Ipecac Syrup. Accessed Lavage 5 minutes after administered soon af- 3/25/06. ingestion removed 90 ter ingestion. With % of substance, but standard-release for- This issue’s authors: dropped to 30 % in 19 mulations, this is gen- JoAnn Chambers, RN minutes post-ingestion erally within 2 hours. Charisse Webb, RN and 13 % in 60 Charcoal should not C. Lewis-Younger, MD. minutes post- be used in patients € ingestion1. Complica- that do not have an To subscribe to this tive therapies such as tions from lavage can intact and functioning newsletter by email, activated charcoal or include aspiration GI tract or where there contact the editor at n-acetylcysteine. pneumonia, esophag- is unacceptable risk of [email protected] eal perforation, aspiration. It does not Page 2 Tox Tips from Florida Poison Information Centers 1-800-222-1222

effectively bind to the follow- Lyte® and NuLytely®) which • CHILDREN 9 months to 6 ing toxins : expels bowel contents without years: 500 cc/hour1 or 2 • S - salts (lithium, sodium) causing electrolyte changes. 25 to 40 cc/kg/hour . • I - iron The first bowel movement usu- Continue until diarrhea is clear. • C - caustics, cyanide ally occurs one hour after initi- Adverse effects: Nausea, • K - K+ (potassium) ating treatment. While there vomiting and fullness may be • P - petroleum products have been no controlled clini- observed with therapeutic use. • A - alcohols cal trials of WBI for poisoned If vomiting occurs, give an patients, case reports have • M - metals (lead, mercury) anti-emetic or decrease rate. shown it to be safe and successful in the following situations: • toxic dose of iron or other products not bound to charcoal 6. Call the poison center • toxic dose of sustained– release or enteric-coated at 1-800-222-1222. drugs which can form concretions that remain in Nurses, pharmacists and 4. Discontinue routine the GI tract physicians at the poison center can gauge whether a toxic use of charcoal (AC) • removal of ingested dose has been ingested and packets of illicit drugs & sorbitol mixtures. advise bedside practitioners • patients with intact and regarding the most appropriate Use of sorbitol or other functioning GI tract decontamination method. cathartics can cause adverse • patients not at risk for Risk Reduction effects and has not been aspiration. shown to improve patient Consider a poison center outcomes. Vomiting is an WBI is given consult as a risk management adverse effect from sorbitol. more effectively measure where your case can Diarrhea and fluid/electrolyte via N/G tube be reviewed with the most up- imbalances that occur with since the dose to-date toxicology information. repeated sorbitol dosing can rate is faster HIPAA-compliant be prevented by use of than most patients will Florida statute 395.1027 water-based “aqueous” drink it. The specifies that a licensed health charcoal. patient should care facility or health care 5. Consider Whole be in a sitting practitioner shall release patient information upon Bowel Irrigation position or with the head of the bed elevated > 45 degrees. request of the regional poison (WBI). Suggested dosing: control center. This preempts any HIPAA confidentiality This method cleanses the • ADULT: 2 liters initially fol- concerns a health care provider bowel by the administration lowed by 1.5 to 2 liters per in Florida may have while of an osmotically balanced hour discussing patients with the non-absorbable solution • CHILDREN 6 to 12 years: poison center. (PEG-ES, GoLytely®, Co- 1000 cc/hour