GUT DECONTAMINATION Flashcards
What is gut decontamination
Removing an ingested toxin from the GIT to decrease its absorption
Goal of GUT decontamination
Eliminate or reduce the potentially life threatening effects of the ingested poison
Which patients are most likely to benefit from gut decontamination
Patients who present with care very early (1-2 hrs) after poison ingestion
three approaches to gut decontamination
Gastric evacuation
Intra-gastric binding
Speeding transit of toxins
Methods used for gastric lavage
Forced emesis and Gastric lavage
Drug used for forced emesis
Ipecac syrup
MOA of ipecac
Irritation of gastric mucosa
When is gastric lavage employed
When forced emesis fails or is contraindicated
Contraindications to ipecac syrup
Decreased consciousness
Ingested corrosive/caustic substances or hydrocarbons with high aspiration potential
What method of gut decontamination exposes the patient to the possibility of tracheal aspiration of stomach contents
Gastric lavage
Indications for gastric lavage
Agents that do not bind to activated charcoal
when forced emesis is contraindicated
Limitations of gastric lavage
large pills or packets
contraindications of gastric lavage
vomiting
greater then an hour since ingestion
toxin already absorbed
corrosive substances and hydrocarbons with aspiration potential
Agents which do not bind to activated charcoal
Lithium, Iron, Lead
Alcohols, hydrocarbons, pesticides
caustics (strong acids and bases
adverse effect of activated charcoal
aspiration of charcoal has been linked with aspiration pneumonia
Contraindications of activated charcoal
Comatose or Convulsing patients unless when airway is protected by endotracheal tueb and a nasogastric tube is in place to administer the charcoal
indications for whole bowel irrigation
drugs not absorbed by activated charcoal
sustained release pills
bodypacking with illicit drugs
Contraindictaions of whole bowel irrigation
Gastric obstruction, perforation or GI hemorrhage
Complications of whole bowel irrigation
vomiting, bloating and rectal irritation
Why cathartics are given with activated charcoal
To prevent constipation
Hasten elimination of charcoal-drug complex
Most commonly used cathartics
Magnesium sulphate
Magnesium citrate
Sorbitol
Contraindications to cathartics
Intestinal obstruction
Caustic ingestions
Complications of cathartics
Hypermagnesemia
Hypernatremia
Magnesium containing cathartics should be avoided in ——-
Renal insufficiency
Caution for patients taking multiples doses of charcoal and sorbitol
Monitor for evidence of impaired fluid and electrolyte imbalance especially in children
Agent used for whole bowel irrigation
Polyethylene glycol at a arte of 2L/hr
MOA of whole bowel irrigation
Causes diarrhea by mass action
