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| concept_decontamination [2025/08/19 06:00] – [2. Activated Charcoal] jkohts | concept_decontamination [2025/08/19 06:28] (current) – [3. Whole Bowel Irrigation] jkohts | ||
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| Activated charcoal is the preferred method for gastrointestinal decontamination when indicated. It is a highly porous adsorbent with a large surface area which adsorbs most toxins. Most drugs are carbon-based and have side chains that may adhere via hydrogen bonding, ion-ion, or weak electrostatic forces. | Activated charcoal is the preferred method for gastrointestinal decontamination when indicated. It is a highly porous adsorbent with a large surface area which adsorbs most toxins. Most drugs are carbon-based and have side chains that may adhere via hydrogen bonding, ion-ion, or weak electrostatic forces. | ||
| - | Its effectiveness decreases with time. If given within 30 minutes of ingestion, charcoal may decrease the absorption of the ingested compound by up to 70%. This drops to 35% after 1 hour. | + | Its effectiveness decreases with time. If given within 30 minutes of ingestion, charcoal may decrease the absorption of the ingested compound by up to 70%. This drops to 35% after 1 hour. The window of effectiveness is generally considered to be within **2 hours for an immediate release preparation and 4 hours for a modified/ |
| - | + | ||
| - | The window of effectiveness is generally considered to be within **2 hours for an immediate release preparation and 4 hours for a modified/ | + | |
| Drugs poorly adsorbed by charcoal: | Drugs poorly adsorbed by charcoal: | ||
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| * Corrosives | * Corrosives | ||
| - | The treatment dose of activated charcoal is **50 g or 1 g/kg activated | + | Dose: |
| - | + | | |
| - | In children charcoal may be added to ice cream to make it more palatable. | + | * Children 💊👶: **Activated |
| + | * 💡In children charcoal may be added to ice cream to make it more palatable. | ||
| Potential complications: | Potential complications: | ||
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| ===== - Whole Bowel Irrigation ===== | ===== - Whole Bowel Irrigation ===== | ||
| - | {{: | + | Whole bowel irrigation (WBI) physically flushes substances from the gastrointestinal tract using large volumes of polyethylene glycol (PEG) solution until the effluent runs clear. Although effective, the practicalities of its implementation mean its use is largely limited to specific poisonings where activated charcoal alone is inadequate. |
| - | WBI physically flushes substances from the gastrointestinal tract using large volumes of polyethylene glycol (PEG) solution until the effluent runs clear. | + | It is recommended early following poisoning and should not be used once a patient is unwell with established haemodynamic instability, as complications are more likely in this group. |
| - | + | ||
| - | While WBI is very effective, the practicalities of its implementation have meant that its use is largely limited to specific poisonings where activated charcoal alone is not satisfactory. | + | |
| - | + | ||
| - | It is recommended early following poisoning and should not be used once a patient is unwell with established haemodynamic instability as complications | + | |
| Drugs amenable to WBI: | Drugs amenable to WBI: | ||
| - | + | | |
| - | | + | * Medications not absorbed by charcoal (e.g. iron, lithium, potassium) |
| - | * Medications not absorbed by charcoal (eg iron, lithium, potassium) | + | * Toxins that can form pharmacobezoars (e.g. salicylates) |
| - | * Toxins that can form pharmacobezoars (eg salicylates) | + | |
| * Body packers | * Body packers | ||
| - | The treatment dose is **1L/h of PEG solution PO or via NGT or (25mL/kg/h if paediatric patient)**. It should be continued until the effluent runs clear – which usually occurs following approximately | + | Dose: |
| - | + | * Adults 💊: **PEG solution | |
| - | Complications of WBI: | + | * Children 💊👶: **PEG solution 25 mL/kg/h PO or via NGT** |
| + | * WBI should be continued until the effluent runs clear – which usually occurs following approximately | ||
| + | * An an antiemetic | ||
| + | Potential complications: | ||
| * Normal anion gap metabolic acidosis | * Normal anion gap metabolic acidosis | ||
| * Aspiration | * Aspiration | ||
| * Distraction from resuscitative priorities | * Distraction from resuscitative priorities | ||
| + | Example of procedure for adult WBI: {{wbi_flow_chart_pic.pdf|NSW PIC Procedure Document for WBI}} | ||
| ===== - References ===== | ===== - References ===== | ||
| Further Reading: | Further Reading: | ||
| - | - Isbister, G. K., and V. V. Kumar. | + | - [[https:// |
| - | - Juurlink DN. Activated charcoal for acute overdose: a reappraisal. Br J Clin Pharmacol. 2016 Mar; | + | - [[https:// |
| - | - Ruben Thanacoody, et al. Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patient. Clinical Toxicology, 2015; 53:1, 5-12, DOI: 10.3109/ | + | - [[https:// |
| ~~REFNOTES~~ | ~~REFNOTES~~ | ||