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Management issues in toxicology.

J L Zimmerman1

  • 1Baylor College of Medicine, Houston, Texas 77030, USA. janicez@bcm.tmc.edu

Seminars in Respiratory and Critical Care Medicine
|August 10, 2005
PubMed
Summary
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Evidence-based toxicology management remains debated. Gastric lavage, whole bowel irrigation, and multiple-dose activated charcoal have limited evidence but can be considered selectively for specific poisoning cases.

Area of Science:

  • Medical Toxicology
  • Emergency Medicine
  • Clinical Pharmacology

Background:

  • Lack of evidence-based information in toxicology leads to management debates.
  • Gastric lavage, whole bowel irrigation, and activated charcoal are common GI decontamination methods with debated efficacy.
  • Limited data exists on optimal use of enhanced elimination techniques for specific toxins.

Purpose of the Study:

  • To review the evidence for gastrointestinal decontamination and enhanced elimination techniques in toxicology.
  • To provide guidance on the selective use of interventions for poisoning management.
  • To clarify the current understanding of the benefits and limitations of various toxicological interventions.

Main Methods:

  • Literature review of studies on gastric lavage, whole bowel irrigation, and multiple-dose activated charcoal.

Related Experiment Videos

  • Analysis of evidence for enhanced elimination of specific toxins like lithium, iron, and cyclic antidepressants.
  • Evaluation of interventions for lithium toxicity and cyclic antidepressant poisoning.

    • Main Results:

    • Gastric lavage may be considered within 60 minutes for life-threatening ingestions, but clinical benefit is not definitively proven.
    • Whole bowel irrigation is safe but lacks established indications; it may be considered for specific ingestions (lithium, iron, sustained-release drugs).
    • Multiple-dose activated charcoal may benefit life-threatening ingestions of certain drugs (carbamazepine, theophylline, etc.), but optimal dosing is unknown.
    • Forced saline diuresis and diuretics are not indicated for lithium elimination; sodium polystyrene sulfonate has unproven clinical benefits and risks.
    • Blood alkalinization with sodium bicarbonate is standard for cyclic antidepressant toxicity, particularly cardiac toxicity, but its benefit for hypotension and seizures is unproven.

    Conclusions:

    • Selective use of GI decontamination and enhanced elimination techniques is warranted based on available evidence.
    • Further research is needed to establish definitive indications and optimal protocols for these interventions.
    • Current evidence supports selective consideration of gastric lavage, whole bowel irrigation, and multiple-dose activated charcoal in specific poisoning scenarios.