TOXICOLOGY■ Confirm tube placement following insertion.
■ Aspirate any available stomach contents.
■ Lavage with 250 mL (10–15 mL/kg in children) aliquots of warm water or
saline.
■ Continue until fluid is clear and a minimum of 2L has been used.
■ Instill activated charcoal through same tube, if indicated.
COMPLICATIONS
■ The primary risks are vomiting, aspiration, and esophageal injury or perforation.
Activated Charcoal
Activated charcoal (AC) is ingested by the patient in order to adsorb poisons
within the GI tract lumen.
DOSE
■ The recommended dose of AC is a 10:1 ratio relative to the ingested poison
(ie, ingestion of 1 g of poison requires 10 g of AC). Hence, the common
ED practice of administering 50 to 100 g (1 g/kg) of AC to an overdose
patient may be inadequate for larger ingestions.
INDICATIONS
■ Patient presents within 1 to 2 hours after ingestion.
■ Patient has ingested a potentially dangerous amount of a poison adsorbed
by charcoal.
CONTRAINDICATIONS
■ Ingested substance is poorly adsorbed by AC (eg, iron, lithium, heavy metals,
toxic alcohols).
■ Diminished level of consciousness/unprotected airway reflexes (AC can be
given by naso- or orogastric tube following intubation)
■ Patient presents over 2 hours after ingestion.
■ Ingestion of caustic agents
■ Cases where endoscopy will be required
RISKS
■ The primary risk of single-dose AC is vomiting.
■ Constipation and diarrhea
■ Bowel obstruction does not occur from single-dose AC.
■ Repeated doses of cathartics given with charcoal may cause dehydration or
electrolyte abnormalities.
Whole-Bowel Irrigation
Whole-bowel irrigation (WBI) flushes the GI tract to decrease the transit time
of luminal contents, thereby limiting absorption.
DOSE
■ Polyethylene glycol (PEG) solution is administered at a rate of 1–2 L/hour.
This rate of administration usually requires a naso- or orogastric tube. End-
points for therapy are the appearance of clear rectal effluent or a total irri-
gation volume of 10 L.
Substances that do not
adsorb to activated charcoal:
Metals (eg, iron, lead,
lithium), caustics,
hydrocarbons, alcohols