You are called to see a 16-year-old girl in the Emergency Department. She was brought in by ambulance after being found unconscious by her parents. She was last seen alive and well 12 hours ago. Several empty bottles of tablets were found beside her.
(b) What is the role of decontamination of the digestive tract?
(b) What is the role of decontamination of the digestive tract?
The role of decontamination of the digestive tract is controversial. This does not refer to Selective Decontamination of the Digestive tract (SDD) which is a form of antimicrobial prophylaxis. The induction of emesis is not favoured. The routine use of gastric lavage and/or activated charcoal has lost favour in the majority of overdose situations because of the limited evidence of benefit, and the possibility of harm (eg. aspiration or trauma). There are some situations where either or both of these techniques should be considered: early presentation (eg. < 1 hour) or presence of a drug which would delay gastric emptying, and presence of toxic drug in high quantities (eg. lethal dose) especially if in a slow release form. Administration of charcoal does not absorb small highly ionised chemicals (eg. metals, electrolytes, acids and alkali). Additional techniques such as repeated activated charcoal (and/or cathartics eg. sorbitol) or whole bowel irrigation (eg. with polyethylene glycol balanced electrolyte solution) may be considered (especially with slow release preparations). Rarely is surgical removal required.
b)
Rationale for decontamination
Techniques of decontamination and their indications
Situations which merit the use of gut decontamination
Criticsm of gut decontamination techniques
The website of the American Academ of Clinical Toxicology has several position statements which might be useful to the fellowship candidate: