Differences

This shows you the differences between two versions of the page.

Link to this comparison view

Both sides previous revisionPrevious revision
Next revision
Previous revision
concept_decontamination [2025/08/19 06:14] – [2. Activated Charcoal] jkohtsconcept_decontamination [2025/08/19 06:28] (current) – [3. Whole Bowel Irrigation] jkohts
Line 13: Line 13:
 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/slow-release preparation**. This window may be extended for agents which result in life-threatening toxicity or following massive ingestions where absorption is expected to be delayed.
- +
-The window of effectiveness is generally considered to be within **2 hours for an immediate release preparation and 4 hours for a modified/slow-release preparation**. This window may be extended for agents which result in life-threatening toxicity or following massive ingestions where absorption is expected to be delayed.+
  
 Drugs poorly adsorbed by charcoal: Drugs poorly adsorbed by charcoal:
Line 24: Line 22:
  
 Dose: Dose:
-  * Adult 💊: **50 g or 1 g/kg activated charcoal PO or via NGT**+  * Adult 💊: **Activated charcoal 50 g or 1 g/kg PO or via NGT**
   * 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.
Line 46: Line 44:
  
 Dose: Dose:
-  * Adults 💊: **PEG solution 1L/h PO or via NGT** +  * Adults 💊: **PEG solution 1 L/h PO or via NGT** 
-  * Children 💊👶: **PEG solution 25mL/kg/h PO or via NGT**+  * 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 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, metoclopramide) is often required.   * An an antiemetic (e.g. ondansetron, metoclopramide) is often required.
  
-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, GK., and VV. Kumar. "Indications for Single-Dose Activated Charcoal Administration in Acute Overdose.Curr Opin Crit Care 17, no4 (2011): 351-7. {{:wikitox:isbister_-_indication_for_sdac.pdf|PDF}} +  - [[https://pubmed.ncbi.nlm.nih.gov/21716104/|PMID: 21716104]]. Isbister GK, Kumar VV. Indications for single-dose activated charcoal administration in acute overdose. Curr Opin Crit Care. 2011;17(4):351-357doi:10.1097/MCC.0b013e328348bf59 {{isbister2011_indication_for_sdac.pdf|PDF}} 
-  - Juurlink DN. Activated charcoal for acute overdose: a reappraisal. Br J Clin Pharmacol. 2016 Mar;81(3):482-7. doi: 10.1111/bcp.12793. Epub 2015 Nov 9. PMID: 26409027; PMCID: PMC4767212. {{:wikitox:juurlink_activated_charcoal_bjcp2016.pdf|PDF}} +  - [[https://pubmed.ncbi.nlm.nih.gov/26409027/|PMID: 26409027]]. Juurlink DN. Activated charcoal for acute overdose: a reappraisal. Br J Clin Pharmacol. 2016 Mar;81(3):482-7. doi: 10.1111/bcp.12793. Epub 2015 Nov 9. PMID: 26409027; PMCID: PMC4767212. {{juurlink2016_activated_charcoal_bjcp.pdf|PDF}} 
-  - Ruben Thanacoody, et al. Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patient. Clinical Toxicology, 2015; 53:1, 5-12, DOI: 10.3109/15563650.2014.989326. {{:wikitox:position_paper_update_whole_bowel_irrigation_for_gastrointestinal_decontamination_of_overdose_patients.pdf|PDF}}+  - [[https://pubmed.ncbi.nlm.nih.gov/25511637/|PMID: 25511637]]. Ruben Thanacoody, et al. Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patient. Clinical Toxicology, 2015; 53:1, 5-12, DOI: 10.3109/15563650.2014.989326. {{thanacoody2015_position_paper_update_wbi_for_gi_decontamination.pdf|PDF}}
  
 ~~REFNOTES~~ ~~REFNOTES~~