
GUT DECONTAMINATION:

The various methods of poison removal from the gastrointestinal tract include:

Emesis

Gastric lavage

Catharsis

Activated Charcoal

Whole bowel irrigation
EMESIS:

The method of including a poisoned patient to vomit is administration of syrup of ipecacuanha (or ipecac)

Source—Root of a small shrub (Cephaelis ipecacuanha or C. acuminata) which grows well in West Bengal.

Active Principles: Cephaeline, emetine, and traces of psychotrine.


Mode of actions:

Local activation of peripheral sensory receptors in the gastrointestinal tract.

Central stimulation of the chemoreceptor trigger zone with subsequent activation of the central vomiting center


Dose:- 30ml(adult), or 15ml (child), followed by 8 to 16 ounces, i.e. 250 to 500 ml approximately, of water
The patient should be sitting up. If vomiting does not occur within 30 minutes, repeat the same dose once more. If there is still no effect, perform
stomach wash to remove not only the ingested poison but also the ipecac consumed.
 Complications:
1. Cardiotoxicity
2. Aspirations pneumonia
3. Oseophageal mucosal or Mallory Weiss tears
 Contra-indications:

Very young (less than 1 year), or very old patients

Pregnancy

Heart Disease

Bleeding diathesis

Ingestion of cardiotoxic poison

Time lapse of more than 6 to 8 hours

GASTRIC LAVAGE

Defined as “GI decontamination technique, that aims to empty stomach of toxic substances, by SEQUENTIAL ADMINISTRATION and
ASPIRATION of small volumes of fluid via OROGASTRIC TUBE”

Used for people, who:
a)
Have consumed a life-threatening dose
b)
Exhibit morbidity within 1-2 hours of ingestion

Beyond 1-2 hours of ingestion, gastric lavage is permitted in the following conditions:
a)
Sustained release preparations
b)
Delayed gastric emptying

Lavage should be considered only if a patient has ingested a life-threatening amount of a poison and presents to the hospital within 1 to
2 hours of ingestion.

Precautions

Never undertake lavage in a patient who has ingested a non-toxic agent

Never use lavage as a deterrent to subsequent ingestions


Contraindications
Haemorrhagic diathesis, oesophageal varices, recent surgery, advanced pregnancy, ingestion of alkali, coma.

Complications

Aspirations pneumonia

Laryngospasm

Sinus bradycardia and ST elevation on the ECG

Perforation of stomach or oesophagus(rare)

CATHARSIS

Catharsis is a very appropriate when used in connection with poisoning, since it means purification.

It is achieved by purging the gastrointestinal tract (particularly the bowel) of all poisonous material.

The two main group of cathartics* used in toxicology include.


Ionic or Saline:
These cathartics alter physico-chemical forces within the intestinal lumen leading to osmotic retention of fluid which attivates motility
reflexes and enhances expulsion.


Saccharides:
Sorbitol (D-glucitol) is the cathartic of choice in adults because of better efficacy than saline cathartics, but must not used as far as
possible in young children owning to risk of fluid and electrolyte imbalance (especially hypernatraemia)

Contraindications:

Corrosives

Existing electrolyte imbalance

Paralytic ileus

Severe diarrhoea

Recent bowel surgery

Abdominal trauma

Renal failure
ACTIVATED CHARCOAL

Activated charcoal is a fine, black odourless, tasteless powder made from burning wood, coconut shell, bone, sucrose, or rice starch,
followed by treatment with an activating agent

Dose:- 1 gm/kg body weight (usually 50 to 100 gm in an adult, 10 to 30 gm in a child).

Contraindications

Absent bowel sounds or proven ileus

Caustic ingestion

Ingestion of petroleum distillates.
Mode of action

Decreases the absorption of various poisons by absorbing them on to it’s surface.

Activated charcoal is effective to varying extent, depending on the nature of substances ingested.

Disadvantages

Unpleasant taste

Provocation of vomiting

Constipation/diarrhoea

Pulmonary aspiration

Intestinal obstruction (especially with multiple-dose activated charcoal)


WHOLE BOWEL IRRIGATION
This is a method that is begin increasingly recommended
for late presenting overdose when several hours elapsed
since ingestion. It involves the instillation of large volumes
of a suitable solution inti the stomach in a nasogastric tube
over a period of 2 to 6 hours producing voluminous
diarrhoea.

Procedure

Insert a nasogastric tube into the stomach and install one of
the recommended solutions at room temperature, at a rate
of 2 litres per hour in adult, and 0.5 litre per hour in
children.

The patient should preferably be seated in a commode. The
use of metoclopramide IV, (10 mg in adults, 0.1 to 0.3
mg/kg in children) can minimise the incidence of vomiting.

The procedure should be continued until the rectal effluent
is clear which usually occurs in about 2 to 6 hours.

Complications

Vomiting

Abdominal distension and cramps

Anal irritation


Contraindications
Gastrointestinal pathology such as obstruction, ileus
haemorrhage, or perforation