Toxin Ingestion Management

Aka: Toxin Ingestion Management, Unknown Ingestion Management, Gastric Decontamination, Decontamination After Toxin Ingestion

1. See Also
   1. Toxin Antidotes
2. General Management
   1. ABC Management
   2. IV Access
   3. Oxygen Delivery
   4. Cardiac monitor
   5. Control Seizures
   6. Control dysrhythmias
3. Protocol: Coma Cocktail (consider for unknown drug ingestion with Altered Level of Consciousness)
   1. Dextrose 25% to 50% (for Hypoglycemia demonstrated by Glucometer)
   2. Naloxone 0.4-2 mg IV (for possible Narcotic Overdose)
   3. Thiamine (Alcoholic or malnourished patients)
   4. Flumazenil (for possible Benzodiazepine Overdose)
      1. Use only with caution (risk of serious withdrawal in Benzodiazepine addiction)
4. Protocol: Skin Decontamination
   1. Remove all clothing and wash skin with soap and water
   2. Protect health care workers from exposure
      1. Example: Organophosphates on clothing
   3. Irrigate eye exposures with Normal saline
5. Protocol: Gastric Decontamination
   1. Indications
      1. Severe ingestion cases as directed by poison control
      2. Gastric Decontamination is no longer recommended for most ingestions
   2. Techniques
      1. Gastric Lavage
      2. Activated Charcoal
      3. Cathartics
      4. Whole Bowel irrigation
6. Protocol: Enhancement of Elimination
   1. See Urinary Alkalinization for Indications
   2. Contraindicated or ineffective measures
      1. Acidification
      2. Forced Diuresis
7. Protocol: Blood filtering
   1. See Hemodialysis for Indications
   2. Charcoal Hemoperfusion Indications
      1. Theophylline
      2. Diphenhydramine (Benadryl)
8. References
   1. Chu (2002) Am J Respir Crit Care Med 166(1):9-15
   2. Erickson (2007) Emerg Med Clin North Am 25(2):249-81
   3. Mokhlesi (2003) Chest 123(2):577-92
   4. Nicholson (1983) Med Clin North Am 67(6):1279-93
   5. Jones (2002) Ther Drug Monit 24(1):150-5