GUT DECONTAMINATION

Question 1

What is gut decontamination

Answer 1

Removing an ingested toxin from the GIT to decrease its absorption

Question 2

Goal of GUT decontamination

Answer 2

Eliminate or reduce the potentially life threatening effects of the ingested poison

Question 3

Which patients are most likely to benefit from gut decontamination

Answer 3

Patients who present with care very early (1-2 hrs) after poison ingestion

Question 4

three approaches to gut decontamination

Answer 4

Gastric evacuation
Intra-gastric binding
Speeding transit of toxins

Question 5

Methods used for gastric lavage

Answer 5

Forced emesis and Gastric lavage

Question 6

Drug used for forced emesis

Answer 6

Ipecac syrup

Question 7

MOA of ipecac

Answer 7

Irritation of gastric mucosa

Question 8

When is gastric lavage employed

Answer 8

When forced emesis fails or is contraindicated

Question 9

Contraindications to ipecac syrup

Answer 9

Decreased consciousness
Ingested corrosive/caustic substances or hydrocarbons with high aspiration potential

Question 10

What method of gut decontamination exposes the patient to the possibility of tracheal aspiration of stomach contents

Answer 10

Gastric lavage

Question 11

Indications for gastric lavage

Answer 11

Agents that do not bind to activated charcoal

when forced emesis is contraindicated

Question 12

Limitations of gastric lavage

Answer 12

large pills or packets

Question 13

contraindications of gastric lavage

Answer 13

vomiting
greater then an hour since ingestion
toxin already absorbed
corrosive substances and hydrocarbons with aspiration potential

Question 14

Agents which do not bind to activated charcoal

Answer 14

Lithium, Iron, Lead
Alcohols, hydrocarbons, pesticides
caustics (strong acids and bases

Question 15

adverse effect of activated charcoal

Answer 15

aspiration of charcoal has been linked with aspiration pneumonia

Question 16

Contraindications of activated charcoal

Answer 16

Comatose or Convulsing patients unless when airway is protected by endotracheal tueb and a nasogastric tube is in place to administer the charcoal

Question 17

indications for whole bowel irrigation

Answer 17

drugs not absorbed by activated charcoal
sustained release pills
bodypacking with illicit drugs

Question 18

Contraindictaions of whole bowel irrigation

Answer 18

Gastric obstruction, perforation or GI hemorrhage

Question 19

Complications of whole bowel irrigation

Answer 19

vomiting, bloating and rectal irritation

Question 20

Why cathartics are given with activated charcoal

Answer 20

To prevent constipation
Hasten elimination of charcoal-drug complex

Question 21

Most commonly used cathartics

Answer 21

Magnesium sulphate
Magnesium citrate
Sorbitol

Question 22

Contraindications to cathartics

Answer 22

Intestinal obstruction
Caustic ingestions

Question 23

Complications of cathartics

Answer 23

Hypermagnesemia
Hypernatremia

Question 24

Magnesium containing cathartics should be avoided in ——-

Answer 24

Renal insufficiency

Question 25

Caution for patients taking multiples doses of charcoal and sorbitol

Answer 25

Monitor for evidence of impaired fluid and electrolyte imbalance especially in children

Question 26

Agent used for whole bowel irrigation

Answer 26

Polyethylene glycol at a arte of 2L/hr

Question 27

MOA of whole bowel irrigation

Answer 27

Causes diarrhea by mass action