The lack of evidence-based information in toxicology results in debate and differing recommendations on management issues. Gastric lavage is often utilized to remove toxins from the stomach but a clinical benefit of the procedure has not been definitively demonstrated. A selective approach is warranted in each patient, and gastric lavage can be considered in patients with life-threatening ingestions if it can be performed within 60 minutes of ingestion. Whole bowel irrigation is a method of GI decontamination utilizing isotonic
electrolyte solution. Although safe, there is currently insufficient data to establish definite indications for use. This technique can be considered for potentially toxic ingestions of
lithium,
iron, and sustained-release or enteric-coated drugs. Multiple-dose
activated charcoal has been used to enhance elimination of drugs already absorbed into the body but the optimum dose and frequency of administration is not established. Based on volunteer studies and limited clinical reports, multiple-dose
activated charcoal may be considered in patients with life-threatening ingestions of
carbamazepine,
dapsone,
phenobarbital,
quinine, or
theophylline. A variety of interventions in addition to
hemodialysis have been proposed to enhance
lithium elimination. Forced saline diuresis and
diuretics are not indicated. Although studies suggest that
sodium polystyrene sulfonate may enhance elimination of
lithium, no beneficial effects on clinical outcomes have been demonstrated and potential complications include
hypokalemia and
hypernatremia. Blood alkalinization for cyclic
antidepressant toxicity has become standard
therapy. Alkalinization is most effective in treating significant
cardiac toxicity.
Sodium bicarbonate, rather than
hyperventilation, should be used initially to alkalinize blood. The benefit of blood alkalinization in the treatment of
hypotension and
seizures is not established.