Dr Eisenstat

5/18/22

1.  What we don’t use anymore: Spotlight on ancient vomiting sticks!, Ipecac syrup (no longer in use 2/2 aspiration risk), EWOL tube (large bore gastric tube), Potassium permanganate
2. Activated Charcoal: binds drugs in a 10:1 ratio.  The earlier the better (1-2 hours) and more efficacious with large, less polar molecules; dose 1-2g/kg (come in 50g tubes); CI with caustic ingestion, hydrocarbons, airway compromise, AMS
3. When to give multiple doses of AC
   1. SDAC: single dose AC, used predominately for salicylates
   1. MDAC: multiple doses AC, “gut dialysis”  for drugs to undergo enterohepatic recirculation; single bolus dose (1g/kg) and then q8 hours (.5g/kg); do not use w/ sorbitol (diarrhoea); does not reduce M&M but does reduce drug rate
      1. Carbamazepine
      1. Lamictal
      1. Colchicine
      1. Dapsone
      1. Phenytoin
      1. Phenobarbital
      1. Amatoxin
      1. Quinine (hypothetical with hydroxychloroquine)

•  Whole Bowel Irrigation (1-2L Go Lytly 1-2 hours) best used for things not well absorbed by AC; packers (drug mules), XR preparations.  Eg: Iron, Lithium, XR BB/CCB, bupropion.  Note that this is a cumbersome and messy endeavour.   
• Gastric lavage: used with colchicine or paraquat (pesticide)
• Take homes: AC best in the first 2 hours (but can argue to give beyond this), be familiar with MDAC, WBI for lithium and extended release substances