Gastrointestinal decontamination in the acutely poisoned patient

Timothy E Albertson,Kelly P Owen,Mark E Sutter,Andrew L Chan

doi:10.1186/1865-1380-4-65

Timothy E Albertson, Kelly P Owen + Show 2 more

Open Access

https://doi.org/10.1186/1865-1380-4-65

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Abstract

ObjectiveTo define the role of gastrointestinal (GI) decontamination of the poisoned patient.Data SourcesA computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources.Study Selection and Data ExtractionClinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient.Data SynthesisThe literature suggests that previously, widely used, aggressive approaches including the use of ipecac syrup, gastric lavage, and cathartics are now rarely recommended. Whole bowel irrigation is still often recommended for slow-release drugs, metals, and patients who "pack" or "stuff" foreign bodies filled with drugs of abuse, but with little quality data to support it. Activated charcoal (AC), single or multiple doses, was also a previous mainstay of GI decontamination, but the utility of AC is now recognized to be limited and more time dependent than previously practiced. These recommendations have resulted in several treatment guidelines that are mostly based on retrospective analysis, animal studies or small case series, and rarely based on randomized clinical trials.ConclusionsThe current literature supports limited use of GI decontamination of the poisoned patient.

Highlights

In the United States, the American Association of Poison Control Centers (AAPCC) reported about 2.4 million poisoning exposures a year in 2006, while the Institute of Medicine in 2001 estimated more than 4 million poisoning episodes with 300,000 hospitalizations and 24,173 poisoning-related deaths [1,2,3]
Gastrointestinal decontamination of the poisoned patient has evolved significantly over the last 2 1/2 decades from a very invasive to a less aggressive approach. This less aggressive approach to GI decontamination followed a series of position statements published jointly by the American Academy of Clinical Toxicology (AACT) and the European Association of Poison Centres and Clinical Toxicologists (EAPCCT) in the late
Urgent surgery is routinely recommended for symptomatic patients with obstruction, bowel perforation or evidence of drug packet rupture [63,64,65,66]

Summary

Introduction

↑ = increased; ↓ = decreased; AC = activated charcoal; AUC = area under serum curve; B = blinded; C = control; CCS = crossover controlled study; GL = gastric lavage; HPP = human poisoned patients; HV = human volunteers; IM = intramuscular; Ip = ipecac; IV = intravenous; LiCl = lithium chloride; MC = multiple center; MDAC = multiple dose AC; NAC = n-acetylcysteine; NB = non-blinded; NC = no change; NR = non-randomized; ob = observational study; R = randomized; Retro = retrospective; SPS = sodium polystyrene sulfonate; SR = sustained release; T 1/2 = serum half-life; VT = variable time events occurred in 41 cases (7.1%) with nausea/vomiting found in 36, bronchoaspiration in 6 and pneumonia in 2 [111]. In 1995, 7.7% of all poisoned patients and 3.56% of all those patients ≤ 5 years old recorded by the AAPCC were treated with AC, but by 2009 the percentage had decreased to 3.4% of all poisoned patients and only 1.48% of patients ≤ 5 years old [27]

Conclusion

54. Janss GJ

60. Position Paper

Findings

97. Burns MM