Gastric Decontamination and Activated Charcoal
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Questions and Answers

What is the primary purpose of adsorbents like activated charcoal when administered orally?

  • To prevent systemic absorption of toxicants (correct)
  • To increase fluid absorption
  • To enhance digestion
  • To neutralize stomach acid

    • What is the best-known adsorbent used in clinical practice for treating toxicant ingestion?

  • Activated charcoal (correct)
  • Sodium bicarbonate
  • Coconut oil
  • Bentonite clay

    • What is the appropriate method for administering activated charcoal via a gastric tube?

  • Using a small gastric tube
  • With high pressure to ensure rapid flow
  • With minimal pressure and proper placement (correct)
  • Diluted with alcohol

    • What is the size of the pores in activated charcoal that contribute to its adsorption properties?

    <p>10 to 20 nm</p> Signup and view all the answers

    Which of the following statements regarding activated charcoal is incorrect?

    <p>Gel formulations are intended for intravenous administration</p> Signup and view all the answers

    What is the approximate drug recovery percentage if activated charcoal is administered 1 hour after ingestion?

    <p>13%</p> Signup and view all the answers

    What is the maximum size of activated charcoal that provides surface area equivalent to a football field?

    <p>1 kilogram</p> Signup and view all the answers

    Which statement best describes the functional surface area of activated charcoal?

    <p>It has a maze of pores that maximize adsorption.</p> Signup and view all the answers

    Which of the following toxicants is NOT mentioned as a candidate for intravenous lipid emulsion therapy (ILE)?

    <p>Atropine</p> Signup and view all the answers

    What is a significant side effect of intravenous lipid emulsion therapy?

    <p>Hyperlipemia</p> Signup and view all the answers

    Intravenous lipid emulsion therapy is particularly effective in cases of poisoning with which type of agents?

    <p>Fat-soluble agents</p> Signup and view all the answers

    Which of the following statements about intravenous lipid emulsion therapy is FALSE?

    <p>It is administered intramuscularly.</p> Signup and view all the answers

    What adverse effect is associated with the use of intravenous lipid emulsion therapy that can recur after stopping treatment?

    <p>Rebound effect</p> Signup and view all the answers

    Which of the following is a common complication that can arise from fat overload syndrome (FOS)?

    <p>Hyperlipidemia</p> Signup and view all the answers

    Which of the following is a component of intravenous lipid emulsion therapy?

    <p>50% fat emulsion</p> Signup and view all the answers

    What can interfere with laboratory testing during intravenous lipid emulsion therapy?

    <p>Hyperlipemia</p> Signup and view all the answers

    What is a key finding regarding the effect of intravenous lipid emulsion (ILE) on serum toxicant concentrations after administration?

    <p>Serum toxicant concentrations decreased after ILE administration.</p> Signup and view all the answers

    What does current data indicate about the lipid sink theory in relation to ILE use for NSAID intoxications?

    <p>Data do not support the lipid sink theory.</p> Signup and view all the answers

    Which statement about the recommendations of Poison Control Centers relating to ILE for NSAID intoxications is correct?

    <p>They do not recommend ILE for most NSAID intoxications.</p> Signup and view all the answers

    What is one reason for inconsistencies in studying the clinical efficacy of ILE?

    <p>ILE dosing regimens differ among studies.</p> Signup and view all the answers

    What consideration is particularly important when administering activated charcoal (AC) in combination with sorbitol?

    <p>There is an increased risk of severe gastrointestinal side effects.</p> Signup and view all the answers

    What is the primary function of cathartics in the management of toxicants?

    <p>To speed the transit time of toxicants through the GI tract</p> Signup and view all the answers

    Which of the following is NOT a contraindication for the use of cathartics?

    <p>Presence of nutritional deficiencies</p> Signup and view all the answers

    What is the recommended dose of sorbitol when administering as a cathartic?

    <p>1 – 2 ml/kg</p> Signup and view all the answers

    Which is true about administering mineral oil as a cathartic?

    <p>It should not be given with activated charcoal.</p> Signup and view all the answers

    What effect does increasing fluid volume in the GI tract have regarding cathartics?

    <p>It stimulates motility and speeds up the expulsion of GI contents.</p> Signup and view all the answers

    Which type of cathartic is NOT classified as an osmotic cathartic?

    <p>Activated charcoal</p> Signup and view all the answers

    In the scenario of a poisoning case with 75 heifers, administered AC is likely considered ____.

    <p>Unnecessary if animals show signs of diarrhea.</p> Signup and view all the answers

    What is the role of cathartics specifically in relation to time-release or enteric-coated compounds?

    <p>They help eliminate solid toxicants more quickly.</p> Signup and view all the answers

    What was the primary hypothesis of the permethrin/ILE clinical trial involving 34 cats?

    <p>Clinical signs would improve with ILE compared to saline control.</p> Signup and view all the answers

    Which of the following is a noted limitation of the permethrin/ILE clinical trial?

    <p>There was no true exposure confirmation.</p> Signup and view all the answers

    What conclusion did the authors make regarding the administration of ILE in cats given a 20x overdose of ivermectin?

    <p>The incidence/severity of intoxication may have been higher without ILE.</p> Signup and view all the answers

    What dosage of ILE was administered in the permethrin clinical trial?

    <p>15 ml/kg over 60 minutes.</p> Signup and view all the answers

    What was the feline half-life of ivermectin reported in the study?

    <p>2.5 +/- 2.2 days.</p> Signup and view all the answers

    What significant factor was associated with increased severity in the intoxication of cats?

    <p>Low body condition score.</p> Signup and view all the answers

    How many cats were reported to have developed signs of intoxication after the ivermectin overdose?

    <p>6 cats.</p> Signup and view all the answers

    What was the form of administration for ivermectin given to the cats in the study?

    <p>Subcutaneous.</p> Signup and view all the answers

    Study Notes

    Gastric Decontamination

    • May require tranquilization/anesthesia
    • Airway protection is mandatory
    • Use as large a gastric tube as possible
    • Make sure it is placed appropriately
    • Use tepid tap water or normal saline (5 to 10 ml/kg)
    • Introduce with minimal pressure
    • Withdraw by aspiration or gravity flow
    • Repeat until washings are clear

    Adsorbents

    • Compounds adsorb the toxicant
    • Reduce or prevent systemic absorption
    • Best known adsorbent: Activated charcoal

    Activated Charcoal (AC)

    • Derived from carbonaceous material
    • Created at high temperatures and oxidizing agents to form a maze of pores
    • Large functional surface area for its volume
    • Network of fine pores (10 to 20 nm in size) that looks like honeycombs under a microscope
    • Adsorption is due to hydrogen bonding, ion-ion, dipole and van der Waals’ forces
    • Only pharmaceutical grade powdered AC is suitable for clinical use

    AC in Veterinary Use

    • Liquid formulations are suitable for administration by nasogastric or gastric tube.
    • Gel formulations are intended for oral administration.
    • Extruded or beaded activated charcoals are considerably less porous and are not suitable for use for adsorbing xenobiotic.
    • Activated charcoal biscuits, tablets, or capsules have limited adsorbing capacity.

    Cathartics

    • Speed the transit time of toxicants through the GI tract
    • ↓ time for toxicant absorption
    • ↓ time for desorption of toxicant from AC
    • Most common: osmotic cathartics
    • Saline cathartics: sodium sulfate, magnesium sulfate
    • Saccharide cathartic: sorbitol
    • Mechanism: increased fluid volume within the GI tract  stimulates motility  speeds expulsion of GI contents
    • Most useful for:
    • Elimination of ingested solid toxicants
    • Time-release or enteric-coated compounds

    Sorbitol

    • Administered as a 70% solution
    • Dose: 1 – 2 ml/kg
    • Typically provided with AC in a slurry solution
    • Should only be given once
    • Contraindications:
    • Lack of bowel sounds
    • Intestinal obstruction or perforation
    • Presence of diarrhea
    • Hypotension or electrolyte abnormalities

    Mineral Oil

    • Laxative for horses and cattle
    • Higher risk for aspiration than other cathartics
    • No longer recommended for use in exposures to lipophilic compounds (like OC insecticides)
    • Do not give with AC (coats AC pores)

    Intravenous Lipid Emulsion Therapy (ILE)

    • First case report to successfully treat a puppy with moxidectin overdose
    • Since then: > 30 published case reports or series published in cats, dogs, goats, horses, ponies, rabbits, birds, guinea pigs, lion
    • Toxicants for which to consider ILE
    • Macrocyclic lactones (eg, ivermectin, moxidectin)
    • Marijuana, synthetic cannabinoids
    • Permethrin
    • Bromethalin
    • NSAIDs – ibuprofen, naproxen, carprofen
    • Barbiturates
    • Pieris japonica
    • Tremorgenic mycotoxins
    • amlodipine, amphetamines, baclofen, diltiazem, lamotrigine, local anesthetics, loperamide, minoxidil
    • ILE – Side effects
      • Interference with other treatment modalities (creation of a lipid sink/shuttle may affect other lipophilic therapeutic drugs administered concurrently with ILE)
      • Hyperlipemia
        • Can interfere with common laboratory testing
      • Recurrence of signs following cessation of ILE therapy (reported in humans) – rebound effect
      • Allergic reactions to the product or its components: Fever, nausea, hypotension, and cardiovascular collapse
      • Fat overload syndrome

    Ivermectin – 20 cats

    • 20 cats given 4 mg/kg ivermectin SQ for ear mites (20x overdose)
    • Ivermectin LogP = 5.83
    • 2 h post, all asymptomatic but treated with ILE
      • 1.5 mL/kg bolus (all cats) + 0.25 mL/kg/min CRI x 30 min for 4 Sphynx cats
    • 6 cats (of the n=16 single bolus) developed signs consistent with intoxication 14-48 h after overdose
      • Mydriasis, ataxia, mild-severe weakness, no menace, stupor, tremors, nystagmus, etc.
    • No serum concentrations measured.
    • Authors’ conclusions:
      • Incidence/severity of intoxication may have been higher if ILE were not preemptively given
      • Low BCS associated with increased severity
      • Feline half-life of ivermectin = 2.5 +/-2.2 days
        • Acknowledge that recovery time is as expected given half-life. Maybe no effect on duration of recovery?
        • Call for laboratory analysis re: ILE/ivermectin

    Studies with NSAID Toxicoses in Dogs

    • Ibuprofen in dogs
    • Naproxen in dogs
    • Carprofen in dogs
    • Study results:
      • Serum toxicant concentrations decreased after ILE administration
      • Data do not support lipid sink theory
      • Poison Control Centers does not currently recommend ILE for most NSAID intoxications

    What are reasons for inconsistencies in studying clinical efficacy with ILE?

    • Patients receive other treatments
    • ILE dosing regimen differs
    • ILE compounds differ
    • Exposure to toxicants/drugs differs
    • Serum concentrations of toxicants following ILE not measured

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    Related Documents

    Decontamination Strategies PDF

    Description

    This quiz covers the essential procedures of gastric decontamination and the use of activated charcoal in clinical settings. Learn the key steps and mechanisms involved in removing toxins from the body, particularly in veterinary medicine. Test your knowledge on the types, applications, and safety of adsorbents like activated charcoal.

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