GI Detox lecture

Question 1

What is activated charcoal

Answer 1

Heated charcoal with steam - forces pores to form in carbon matrix

Question 2

Dose of Charcoal

Answer 2

1g/kg up to dose of 50 g ( can repeat half dose every 4-6 hours)

Question 3

Give Charcoal by when

Answer 3

by 2 hours ( but no evidence to suggest either)

Question 4

Can you add flavoring to charcoal

Answer 4

Yes chocolate

Question 5

When is charcoal not effective

Answer 5

caustic ingestions ( you plan to scope) 
Metals 
Alcohols 
Inorganic ions 
Hydrocarbons 
Alkali/ Acids

Question 6

Contraindications for charcoal

Answer 6

Depressed LOC  ( do not intubate just to give charcoal ) 
Bowel obstruction, perf, ileus , need for endoscopy, corrosives, low viscosity/highly volatile hydrocarbons ( may increase risk of aspiration)

Question 7

Charcoal is good for which meds

Answer 7

Most med ingestions - but may not be safe in non meds

Question 8

Charcoal problems

Answer 8

Repeated doses cause constipation ( only in multiple doses would sorbitol be indicated )

Question 9

Why is sorbitol not used with charcoal

Answer 9

Aspiration risk ( not indicated in the first few doses )

Question 10

Whole bowel irrigation

Answer 10

Miralax - or go lightly - dose 20-40 ml/kg /hr to max of 500-2000-

Question 11

WB irrigation indicated specifially for

Answer 11

Coated ampicilin, lithium

Question 12

Nu-lightly

Answer 12

different from miralax - has electrolytes and flavor

Question 13

WB irrigation indication for

Answer 13

anythign extended release 
Large ingestion of metals - 
anything that increased drug motility 
drug packets 
pharmcobezoars ( e.g. aspirin )

Question 14

Contraindications

Answer 14

Perf ileus obstruction, GI bleed

Question 15

Gastric lavage indications/ evidence

Answer 15

may be contraindicated in kids

Question 16

Gastric lavage adverse effects

Answer 16

laryngospam
lavage of tracheobronchial tree
Risk of aspiration in ICU
May propel toxins past pyloris and increased absorption