Management issues in toxicology

The lack of evidence-based information in toxicology results in debate and differing recommendations on management issues. Gastric lavage is often uti lized to remove toxins from the stomach but a clinical benefit of the proce dure has not been definitively demonstrated. A selective approach is warran ted in each patient, and gastric lavage can be considered in patients with life-threatening ingestions if it can be performed within 60 minutes of ing estion. Whole bowel irrigation is a method of GI decontamination utilizing isotonic electrolyte solution. Although safe, there is currently insufficie nt data to establish definite indications for use. This technique can be co nsidered for potentially toxic ingestions of lithium, iron, and sustained-r elease or enteric-coated drugs. Multiple-dose activated charcoal has been u sed to enhance elimination of drugs already absorbed into the body but the optimum dose and frequency of administration is not established. Based on v olunteer studies and limited clinical reports, multiple-dose activated char coal may be considered in patients with life-threatening ingestions of carb amazepine, dapsone, phenobarbital, quinine, or theophylline, A variety of i nterventions in addition to hemodialysis have been proposed to enhance lith ium elimination, Forced saline diuresis and diuretics are not indicated. Al though studies suggest that sodium polystyrene sulfonate may enhance elimin ation of lithium, no beneficial effects on clinical outcomes have been demo nstrated and potential complications include hypokalemia and hypernatremia, Blood alkalinization for cyclic antidepressant toxicity has become standar d 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.