Poison Tag's Archives
Haemodialysis, peritoneal dialysis, haemoperfusion, exchange transfusion and forced diuresis have all been used in attempts to increase the rate of removal of drugs and poisons. However, the amount of active drug removed is often disappointingly small, and the indications for the use of such measures is very limited.
Nevertheless, poisoned patients are often unnecessarily subjected to these potentially harmful measures, and the literature is full of anecdotal accounts of miraculous recovery attributed to such treatment (Winchester et al. 1977). Properly controlled clinical trials are difficult to carry out, and very few have been published. With the possible exception of forced alkaline diuresis for poisoning with salicylate and long acting barbiturates such as phenobarbitone, none of these methods for enhancement of drug removal has ever been shown to reduce morbidity or mortality in poisoned patients (Todd 1984).
Indeed, some studies suggest the opposite result. This is not to say that such measures are never necessary, or indeed sometimes life saving, but a more critical appraisal of their role is required.
Absorption, Acidic, Alkaline, Analytical, Bentonite, Chemical, Clinical, Dialysis, Dose, Fraction, Method, Paracetamol, Poison, Recovery, Therapeutic, Toxic, Treatment, Trial
Synopsis of Important Principles
1. Specific antidotal therapy is available for very few poisons. The mainstay of treatment of severe poisoning is intensive supportive therapy and good nursing care.
2. The great majority of poisoned patients recover with intensive supportive therapy alone, and enthusiastic claims for the success of other treatment often cannot be justified.
3. With some important exceptions, the management of poisoning is not altered by knowledge of plasma drug concentrations. There are many pitfalls in the interpretation of drug concentrations in poisoned patients, especially when nonspecific analytical methods are used.
Antidotal, Blood, Care, Circulation, Concentration, Dialysis, Diffuse, Dosage, Dose, Drug, Effect, Indication, Inhibition, Intensive, Mechanism, Metabolic, Method, Mortality, Nursing, Overdose, Pharma, Plasma, Poison, Specific, Support, Synopsis, Technique, Therapy, Toxic, Treatment, Volume
Gastric Aspiration and Lavage
Although unabsorbed drug in the stomach may be removed by gastric aspiration and lavage its usefulness in practice has been seriously questioned (Proudfoot 1984). Most drugs and poisons seem to be absorbed rapidly and this technique is unlikely to be productive more than 4 hours after ingestion, unless gastric emptying has been delayed by opioid analgesics, anticholinergic agents, central nervous system depressants, and possibly salicylates. In such circumstances gastric lavage may be worthwhile up to 12 hours after ingestion.
It is said to be contraindicated after ingestion of corrosives and hydrocarbons such as paraffin because of the risks of perforation and lipoid pneumonia, respectively.
Aspiration, Corrosives, Depress, Effect, Fatal, Gastric, Ingestion, Nervous, Poison, Practice, Residual, Risk, Sensitivity, Sodium, Sulphate, Technique, Toxic, Treatment, Tube
