Problems for Discussion - 1 - Decontamination

Read:

Pond et al Gastric emptying in acute overdose: a prospective randomised controlled trial Med J Aust 1995 Oct 2;163(7):345-9 PMID7565257

Eddleston et al Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial The Lancet 2008;371:579-587 [fulltext] [PDF 260 KB]

Discuss the possible limitations of these trials.
What are the differences in patient groups?

Discuss decontamination in the following scenarios:

1. A 50 kg female presents having ingested 6 grams of paracetamol 5 hours ago.
2. A 70 kg male presents having ingested 14 grams of paracetamol 3 hours ago.
3. A 70 kg male presents having ingested 14 grams of paracetamol 1 hour ago.
4. If you offer decontamination to the patient and they refuse, what do you do?

Discuss decontamination in the following scenarios:

1. A 60 kg man presents with ingestion of 20 mg of colchicine 1 hour ago.
2. A 60 kg man presents with ingestion of 20 mg of colchicine 4 hour ago.
3. He refuses treatment, what do you do?

Discuss decontamination in the following scenarios:

1. A child aged four presents with ingestion of iron tablets: 20 Ferro-Gradumet.
2. A 60 kg adult ingests 10 g of paracetamol and 18 g of carbamazepine slow release formulation

Discuss decontamination in the following scenario:

A man presents in an agitated state, he believes drug dealers will kill him. He is not paranoid. It turns out that he has swallowed four packets of cocaine two days before and flown into the country on his Frequent Flyer points.