Gastrointestinal Decontamination

Gastrointestinal Decontamination

Gastrointestinal Decontamination is a medical procedure employed in the case of poisoning with oral intoxicant agents. This method has been practiced throughout the world and for extended periods of time, theory suggests that by applying gastric and bowel emptying procedures the toxins absorption process is hindered, and may even result in partial or complete elimination of the toxins, while also preventing the worsening of the patient’s condition and assisting with the recovery. There are several procedures through which Gastrointestinal Decontamination can be applied. These include administration of Activated Charcoal, whole bowel irrigation, gastric lavage and administration of Ipecac.

Activated Charcoal is commonly used as a Gastrointestinal Decontamination procedure in cases where the patient is known or suspected to have ingested a large amount of poison within at most one hour before the procedure is applied. However, even if more than one hour has passed, it is still possible for the treatment to be effective. This is the mainstay procedure employed in emergency cases, and all emergency room personnel are trained to apply this technique.

Whole bowel irrigation is recommended in cases of Lithium intoxications instead of Activated Charcoal administration. Also, it is indicated in cases where the patient has ingested large quantities of enteric-coated drugs with sustained release, for the removal of illicit drugs or large quantities of iron. However, this technique should not be used on a regular basis.

Gastric lavage is another procedure which may be applied however due to its collateral effects it should only be used if the intoxication is life threatening despite proper attempts at managing the condition. The procedure may only be applied under the close supervision of specialized health care professionals.

Ipecac administration used to be used on a large scale as a domestic remedy to intoxications. However, the procedure has been deemed inappropriate for domestic use and currently it is recommended that it is not used as a home treatment. In case you suspect that someone has been poisoned, it is best that you do not attempt to treat them by any means. Contact the local poisons center, your personal doctor or the nearest hospital instead.

Gastrointestinal Decontamination Description

Gastrointestinal Decontamination is commonly performed in emergency situations. One of the most common procedures employed is gastric lavage, in patients who are have ingested large quantities of toxic substances (especially in situations where it is impossible to administer a large enough dose of Activated Charcoal). Also, this procedure may be applied in cases where the nature of the ingested substance and time of ingestion are unknown, as well as in situations when the patient is hemodynamically unstable. However, this procedure may not be applied if the patient has swallowed corrosive substances, hydrocarbons or sharp objects or if he or she is suffering from esophageal varices.

The health care professional performing the Gastrointestinal Decontamination needs to assess the patient’s respiratory, cardiovascular and neurological functions and ensure that the airway is not blocked. The patient should be positioned on his or her left side in order to prevent aspiration and allow for easier passage of tube. Any dentures must be removed, as well as partial plates. The health care professional must equip protective equipment (gown, gloves and goggles). The clamps must be closed on drainage and irrigation bags; fill the irrigation bag with normal saline or tap water and hang on the IV pole above the patient before setting the drainage bag in position below the patient and securing it with Velcro straps. Insert the gastric lavage tube. It is recommended to check the placement (typically by employing the use of a piston syringe to insert air through the tube and checking for bubbling sounds in the patient’s stomach). The lavage tube must be connected firmly to the connector after its end has been cut at the appropriate size. Open the clamps on the irrigation bag and allow 300 to 500 ml of liquid to drain into the patient’s stomach, then close the clamp on the irrigation bag, opening the one on the drainage. Once the draining is complete, repeat the procedure until the stomach has been cleared in order to achieve full Gastrointestinal Decontamination.

Gastrointestinal Decontamination Related Medication

Currently, the main Gastrointestinal Decontamination procedure employed in cases of acute oral poisoning is administration of Activated Charcoal. This substance has been shown to bind to poison and to prevent the toxins’ absorption into the organism through the intestinal tract. The usual dose is of 1g / kg of body weight, typically administered in one single dose – however once the poisoning agent has been identified, it is possible that additional doses are administered. While this remedy has proven to be a very effective method of Gastrointestinal Decontamination if administered shortly after the poisoning agent has been ingested (typically within one hour or less), it has a reduced effect as more time passes and may be completely ineffective in case of long term exposure to toxins (for example, in the case of long term use of toxic substances).

The Gastrointestinal Decontamination through administration of Activated Charcoal has been shown to work through two mechanisms: the medicine binds the toxin in a reversible manner (which allows Sorbitol or other cathartic medication to be added as part of the therapy) and prevents its absorption through the gastrointestinal walls, and also hinders the enterohepatic circulation of several substances (certain toxins and drugs, as well as of their metabolites). The combined actions result in a higher rate of success and a faster rate of recovery. The use of this procedure is however contraindicated when the poisoning agent is an alkali, an acid or a product based on petroleum. As such, it is recommended that proper investigations are performed to determine the nature of the toxic substance before applying the procedure.

The Activated Charcoal doses may only be administered by specialized health care professionals. Severe consequences may occur if the Gastrointestinal Decontamination procedure is applied incorrectly and the substance enters the patient’s lungs. Pulmonary aspiration with possibly lethal results is one of the most common adverse reactions encountered in such situations. In such situations immediate medical intervention is necessary to avoid and manage any complications.