Increasing Drug Elimination
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
I. Catharsis
Cathartics are used by some toxicologists for stimulation of peristalsis to increase drug elimination of unabsorbed drugs and poisons and the activated charcoal slurry.
Indications
Do not give cathartics to patients with suspected intestinal obstruction
Avoid sodium-based cathartics in patients with hypertension, renal failure and CCF.
Castor oil, Bisacodyl, Magnesium sulfate (Epsom salts), Magnesium hydroxide (milk of magnesia) Lactulose.
II. Whole bowel irrigation
Whole bowel irrigation uses large volumes of polyethylene glycol electrolyte solution to mechanically cleanse the intestinal tract
Because of the composition of the irrigating solution, there is no significant gain or loss of systemic fluids or electrolytes.
Indications
WBI is especially useful for massive iron ingestion in which intact tablets are visible on abdominal radiographs. Also used for ingestion of sustained release and enteric coated tablets as well as swallowed drug filled packets.
Contraindications
Do not use in patients with suspected intestinal obstruction
Use with caution in patients with depressed airway protective reflexes.
III. Forced alkaline diuresis
Acidic drugs such as salicylates, phenobarbital are rapidly excreted with alkaline urine.
It hazardous and the risk of complications such as pulmonary edema and electrolyte imbalance outweighs its benefits.
Acidification (Amphetamine, phencyclidine) is not very effective and is contraindicated in the presence of rhabdomyolysis or myoglobinuria.
IV. Hemodialysis
Known or suspected potentially lethal amounts of a dialyzable drug
Poisoning with deep coma, apnea, severe hypotension, fluid and electrolyte imbalance, extreme body temperature changes that cannot be corrected by conventional measures
V. Peritoneal dialysis
It is not very efficacious and is not used commonly. Can be used for patients severely poisoned with ethylene glycol.
VI. Hemoperfusion
This technique is rarely used. The blood passes through devices containing adsorbent particles, such as activated charcoal or resins to which drugs are absorbed.
Antidotes
An antidote is a substance which can counteract a form of poisoning. OR A substance used to treat poisoning which has a specific action depending on poison.
Chemical antidotes
It neutralizes the poison by changing the chemical nature of poison e.g., dimercaprol
Mechanical antidotes: It
It prevents the absorption of poison e.g., activated charcoal
Physiological antidote
It counteracts the effect of poison by producing opposite physiological effects e.g., naloxone.