Adult Medical Emergency Handbook - Scottish Intensive Care Society

GUT DECONTAMINATION/DRUG ELIMINATION
• Induced vomiting is of no benefit, is potentially hazardous, and
should be avoided.
• Absorption of many drugs may be reduced by oral activated
charcoal (50 g) within the first hour post ingestion. Activated
charcoal must not be given without adequate airway protection or
if there is a paralytic ileus (absent bowel sounds).
• Some substances including iron, lithium, methanol and ethylene
glycol are not bound to charcoal.
• Repeated doses of activated charcoal enhance elimination of
certain drugs, and can be beneficial beyond 1 hour post-ingestion:
carbamazepine, phenobarbitone, quinine and theophylline.
• Gastric lavage is rarely necessary, and should be considered only
if a life-threatening dose of chemical or drug have been ingested
within 1 hour.
• Gastric lavage should NOT be undertaken in patients with reduced
conscious level or inadequate airway protection, or after ingestion
of petroleum distillates or corrosives due to the risk of aspiration.
If in doubt discuss with the NPIS.
• Whole bowel irrigation with osmotic laxatives may reduce
absorption of some drugs that are not adsorbed by charcoal. It is
occasionally necessary for patients who have ingested packages
of illicit drugs (e.g. ‘body-stuffers’).
• Urinary alkalinisation may increase elimination of some drugs (e.g.
salicylate), and can protect against renal impairment in patients
with rhabdomyolysis.
• Haemodialysis can improve outcome in some cases of severe
toxicity, e.g. digoxin, ethylene glycol, lithium, methanol and
salicylates. Further information is available from TOXBASE® and
NPIS.
EMERGENCY INVESTIGATIONS
• See table for suggested investigations
• Perform arterial blood gas if airway is compromised,
hypoventilation or metabolic acidosis is suspected.
Carboxyhaemoglobin should also be measured in cases of
suspected carbon monoxide poisoning.
• Chest X-ray should be performed if the patient is persistently
hypoxic or after inhalational exposure.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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