Kerala State Drug Formulary.pdf

General Topics
DECONTAMINATION
The vast majority of serious poisonings are due to ingestion of toxic
substances and gastrointestinal decontamination should be done without
delay.
1. If the patient is fully conscious and the general condition is
satisfactory, he can be induced to vomit by tickling the pharynx or
administration of gastric irritants such as concentrated common
salt solutions 200 -400 mL. Induction of vomiting is contraindicated
in case of corrosive poisons and if the patient is comatose.
2. Gastric lavage.
• Using large bore (36 - 40 F) orogastric tube.
• Indicated in comatose patients as well as alert
patients.
• Patients in Trendelenburg position and left lateral
position.
• Decrease risk of aspiration by using cuffed
endotracheal tube if available.
• After contents of the stomach are aspirated, aliquots
of water at room temperature(50 -250 mL) should be
administered and aspirated until the return is clear.
• Contraindicated in patients who have ingested
corrosives or petroleum distillate hydrocarbons.
3. Activated charcoal.
• This acts by adsorbing molecules of chemicals on its
surface, thereby inhibiting their absorption
• Dose is 1 g/kg suspended in water and introduced
through the orogastric tube.
• 2 or 3 doses of charcoal given at 4 hourly intervals
may be of more use than a single administration.
Drugs adsorbed by charcoal Drugs not adsorbed by charcoal
1. Amphetamine 1. Ferrous sulphate
2. Chlorpheniramine 2. Malathion
3. Phenytoin 3. Acids
4. Aspirin 4. Alkalis
5. Cyclic antidepressants 5. Alcohol
6. Chlorpromazine 6. Lithium
7. Quinine
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