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(Barré) #1

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
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