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concept_decontamination [2025/08/19 06:14] – [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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Dose: | Dose: | ||
- | * Adult 💊: **50 g or 1 g/kg activated charcoal | + | * Adult 💊: **Activated charcoal |
* Children 💊👶: **Activated charcoal 1 g/kg PO or via NGT** | * Children 💊👶: **Activated charcoal 1 g/kg PO or via NGT** | ||
* 💡In children charcoal may be added to ice cream to make it more palatable. | * 💡In children charcoal may be added to ice cream to make it more palatable. | ||
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Dose: | Dose: | ||
- | * Adults 💊: **PEG solution | + | * Adults 💊: **PEG solution |
- | * Children 💊👶: **PEG solution | + | * Children 💊👶: **PEG solution |
* WBI should be continued until the effluent runs clear – which usually occurs following approximately 5 L of fluid for adults. | * WBI should be continued until the effluent runs clear – which usually occurs following approximately 5 L of fluid for adults. | ||
* An an antiemetic (e.g. ondansetron, | * An an antiemetic (e.g. ondansetron, | ||
- | Complications of WBI: | + | Potential complications: |
* Normal anion gap metabolic acidosis | * Normal anion gap metabolic acidosis | ||
* Aspiration | * Aspiration | ||
* Distraction from resuscitative priorities | * Distraction from resuscitative priorities | ||
- | {{wbi_flow_chart_pic.pdf|NSW PIC Procedure Document for WBI}} | + | 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~~ |