0071643192.pdf

TOXICOLOGY

INDICATIONS

■ Removal of ingested drug packets (eg, body stuffers)

■ Large ingestion of a sustained-release drug

■ Potentially toxic ingestion that cannot be treated with activated charcoal

(eg, lithium, lead, iron)

CONTRAINDICATIONS

■ Diminished level of consciousness/unprotected airway reflexes (intubate

first)

■ Decreased GI motility or bowel obstruction

■ Significant GI hemorrhage

■ Persistent emesis

COMPLICATIONS

■ The primary risk associated with WBI is vomiting.

■ Patient discomfort: Bloating, cramping, and flatulence

■ WBI with balanced PEG solutions does not generally cause electrolyte

abnormalities.

PRINCIPLES OF ENHANCED ELIMINATION

The goal of enhanced elimination is to increase the clearance of a poison

from the body afterit has been systemically absorbed. The following methods

of enhanced elimination are available (see Table 6.3):

■ Multiple-dose activated charcoal

■ Urinary alkalinization

■ Hemodialysis

Common indications for

whole-bowel irrigation: Drug

packets, sustained-release

formula, metals

Endpoints for whole-bowel

irrigation: Clear rectal effluent

or total irrigation volume

of 10 L

TABLE 6.3. Enhanced Elimination: Drug Characteristics and Examples

TECHNIQUE DRUGCHARACTERISTIC EXAMPLES

Multiple-dose Enterohepatic circulation Phenobarbital

activated charcoal Carbamazepine

Theophylline

Aspirin

Urinary alkalinization Weak organic acid with Aspirin

renal excretion Phenobarbital

Formic acid

Hemodialysis Low molecular weight, Lithium

low plasma protein binding, Aspirin

small volume of distribution, Alcohols

poor endogenous clearance

OR

Acidosis caused by toxin Metformin