0071643192.pdf

TOXICOLOGY

PRINCIPLES OF GASTROINTESTINAL DECONTAMINATION

Gastrointestinal (GI) decontamination refers to therapies that may decrease
the amount of poison absorbed from the GI tract lumen.

The following methods of GI decontamination are available:

■ Induced emesis
■ Gastric lavage
■ Activated charcoal
■ Whole-bowel irrigation

Induced Emesis

Induced emesis utilizes syrup of ipecac to induce vomiting, theoretically emptying
the stomach and reducing absorption of an ingested agent. Syrup of ipecac induces
vomiting by activation of both local and central emetic sensory receptors.

TABLE 6.2. Toxidromes

TOXIDROME COMMONAGENTS PRESENTATION TREATMENT

Anticholinergic Antihistamines Altered mentation Benzodiazepines

(see also p. 331–332) Jimsonweed (scopolamine) Dry, flushed skin Physostigmine (rarely

Deadly nightshade (atropine) Mydriasis indicated)

Hyperthermia

Seizures

Tachycardia

Urinary retention

Cholinergic Organophosphates Altered mentation Atropine

(see also p. 332–333) Carbamates Bradycardia 2-PAM (for organophophates)

Sarin Bronchospasm

↑ Secretions

Miosis

N/V, defecation

Seizures

Urination

Sympathomimetic Ephedrine Agitation Benzodiazepines

(see also p. 379–381) Diaphoresis Sodium bicarbonate

Ma Huang Hallucinations (for wide complex

Cocaine HTN dysrhythmias)

Amphetamines Hyperthermia

Mydriasis

Muscular rigidity

Tachycardia

Opioid Morphine CNS depression Naloxone

(see also p. 366–367) Heroin Bradycardia

Dextromethorphan Hypothermia

Miosis

Respiratory depression