Specific Management
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.
Indications
Recent ingestion
Toxic substance
Toxic amount
Contraindications
Ingestion of corrosive agents
Petroleum distillates (kerosene, gasoline, turpentine, and related petroleum products, such as red furniture polish). Further esophagus injury or pulmonary aspiration may result.
Vomiting may cause additional poison to enter the lungs. However, the quantity of poison swallowed, or special petroleum additives may make gastric lavage or the use of cathartics advisable.
o If a physician or poison control center can-not be reached, give the victim 30 to 60 ml of vegetable oil.
o Transport the victim immediately to a medical treatment facility.
1.Induced emesis
Emesis can be induced by using syrup of ipecac if given very soon after ingestion. Administered within 30-60 minutes of ingestion
Mechanism
Direct irritant effect on GI mucosa and central emetic effect. Emesis occurs in 95% of patients within 30 minutes.
2. Adsorbents
Activated charcoal effectively adsorb almost all drugs and poisons.
Poorly adsorbed substances include
- Iron
- Lithium
- Potassium
- Sodium
- Acids
- Alcohols
Charcoal is made from coal, wood, or other substances. It becomes 'activated charcoal' when high temperatures combine with a gas or activating agent to expand its surface area. team activation and chemical activation (Phosphoric acid)
Indications
Activated charcoal is more effective than ipecac and is used for adsorption of drugs in stomach and intestine.
Contraindications
Should not be used for comatose or convulsing patients unless given by gastric tube and the airway is protected by a cuffed endotracheal tube
Patients with ileus or intestinal obstruction
Gastric lavage
Gastric lavage is more effective for liquid poisons or small pill fragments than for intact tablets. Useful when started within 60 minutes after ingestion
Disadvantage
Pulmonary aspiration
Indications
Used after large ingestions e.g., overdose of aspirin
For collection of samples for examination and identification of poison
Contraindications
Comatose patients as pulmonary aspiration can occur
Technique of gastric lavage
Gently insert a lubricated soft stomach tube through the mouth into the stomach.
Aspirate and save the contents
Lavage repeatedly with 50 -100 mL aliquots fluid until the return fluid is clear.
Use lukewarm tape water or saline.
In comatose patients the danger of aspiration pneumonia is reduced by performing endotracheal intubation.