Treatment Of Toxic Ingestions Research Articles

The role of whole bowel irrigation in the treatment of toxic ingestions.

There is no high-quality evidence regarding the benefit of any gastrointestinal decontamination procedure in the overdose patient. The original and twice reaffirmed position of the AACT and EAPCCT is based upon the best evidence and practical considerations. WBI was recommended as a treatment for the ingestion of modified release pharmaceuticals, iron salts and other substances not adsorbed by activated charcoal. This is a best evidence recommendation.

FACILITATION OF THE TREATMENT OF TOXIC INGESTION BY ENDOSCOPIC GASTRIC DECONTAMINATION OF PILL FRAGMENTS IN A 2 MONTH OLD INFANT

122 A 2 month old male infant was brought for emergency treatment after noting a change in mental status. The patient had been inadvertently left unattended for approximately 6 hours with a 2 year old sibling and on discovery, several open single dose pill containers were noted and emptied of their contents. These included a 'cold pill' (acetaminophen 325 mg, pseudoephedrine 30 mg, dextromethorphan 10 mg), ibuprofen (200 mg), and calcium carbonate (420 mg). A flat plate of the abdomen obtained on initial evaluation showed more than 30 pill fragments in the stomach. It was estimated that the patient ingested at least 1625 mg (230 mg/kg) of acetaminophen, 150 mg of pseudoephedrine, 200 mg of ibuprofen, 50 mg of dextromethorphan, and 20 or more tablets of calcium carbonate. The patient received activated charcoal and gastric lavage, but few of the pill fragments were retrieved. In an effort to facilitate gastric decontamination, an upper endoscopy was performed. A prototype for the new bard "half snare/net" was used to remove pill fragments. Eighteen of 32 pill fragments were retrieved after 14 passes of the upper endoscope. Gastric pill fragment analysis confirmed a toxic ingestion of acetaminophen and pseudoephedrine. Initial acetaminophen level obtained 6-8 hours after ingestion was 201. The patient subsequently received 17? doses of n-acetyl cysteine and acetaminophen levels steadily decreased, to a level of<10 twenty-four hours after admission to the hospital. Initial blood gas showed a pH of 7.21 and a HCO3 of 38. The patient initially required mechanical ventilation, but was weaned from the ventilator within 24 hours of admission and transferred out of the intensive care unit 48 hours after admission. The patient was subsequently discharged home without apparent sequelae. Conclusion: Endoscopic gastric decontamination of pill fragments may provide a useful adjunct in the treatment of toxic ingestions in children. Instruments designed specifically for pill removal would aid in this procedure.

Facilitation of the treatment of toxic ingestion by endoscopic gastric decontamination of pill fragments in a 2 month old infant

Facilitation of the treatment of toxic ingestion by endoscopic gastric decontamination of pill fragments in a 2 month old infant

Chronic Ipecac Poisoning in Infancy: A Case Report

Syrup of ipecac is an important component in the treatment of acute toxic ingestion. The American Academy of Pediatrics1 recommends that syrup of ipecac be kept in the household to be used for the conscious patient in the treatment of toxic ingestion when advised by a physician. Syrup of ipecac is not without toxicity, however, and this increased availability opens the door to poisoning by ipecac itself. Toxicity has been observed in adults ranging from direct noxious effects on the gastrointestinal system2-4 to cardiomyopathy,2,5 generalized myopathy,6,7 and fatalities secondary to dehydration or electrolytic distubrances.8 Little is known about the signs and symptoms of ipecac toxicity in infants and children.

Effects of emetic and cathartic agents on the gastrointestinal tract and the treatment of toxic ingestion.

Emetic drugs and saline cathartics produce direct or reflex changes in gastrointestinal motility. The changes in gastrointestinal smooth muscle function may be important in the rapid oral or rectal expulsion of gastrointestinal contents, effects which serve as a basis for emetic and cathartic drug use in the treatment of toxic ingestion. Because of difficulties in recording gastrointestinal smooth muscle contractile activity from the intact, unanesthetized animal or man, relatively few studies have attempted to characterize the changes in gastrointestinal motility preceding vomiting. Limited results from past studies and the results of more recent studies employing improved technology suggest that pharmacological activation of the emetic reflex is accompanied by characteristic movements of the stomach and small intestine. The gastric response consists of initial muscle relaxation and an expansion of gastric volume. The intestine responds with a contraction, which begins in the distal ileum and migrates orad over the entire small intestine immediately before active retching. The changes in gastric and intestinal motility may be initiated by structures in the central nervous system and may be an important component of the emetic reflex. This article urges more active research to characterize the gastrointestinal emetic response and to investigate more generally the therapeutic value of emesis in the treatment of toxic ingestion. Emphasis should be placed on the clinically important emetic drugs apomorphine and syrup of ipecac. Studies comparing the efficiency of removal of gastrointestinal contents, resultant blood levels of orally administered drugs with and without emesis, differences in the gastrointestinal emetic response between agents and the pharmacology of the gastrointestinal emetic response should be performed. Studies should also be conducted to determine the pharmacology of the emetic sensory receptors in the gastrointestinal tract and the intraluminal physical-chemical or gastrointestinal physiological factors influencing gastrointestinal emetic sensory receptor activation. The results would demonstrate the value of emesis in various poison cases and help establish criteria for use and selection of emetic drugs. No less experimental attention should be devoted to the cathartic drugs.(ABSTRACT TRUNCATED AT 400 WORDS)