Syrup of ipecac, an emetic that exerts its action through irritation of the gastric mucosal and by stimulation of the vomiting center, is no longer recommended for immediate treatment at home. The American Academy of Pediatrics (AAP) (Committee on Injury, Violence and Poison Prevention, 2003) recommends that existing ipecac in the home should be disposed of safely and the first action for a caregiver of a child who may have ingested a toxic substance is to consult the local poison control center. If the Poison Control Center cannot be reached, the child should be taken to the nearest emergency department. No emetic or other substance should be given at home without consultation with a PCC or physician.
If the child is admitted to an emergency facility, gastric lavage may be performed to empty the stomach of the toxic agent. Lavage is indicated for young infants in whom ipecac is contraindicated; if the patient is comatose or convulsing or requires a protected airway; or if the ingested poison is rapidly absorbed (strychnine or cyanide). The use of lavage in petroleum distillate poisoning remains controversial because of the danger of aspiration. When lavage is performed, the largest-diameter tube that can be inserted is used to facilitate passage of gastric contents.
Another method of decontaminating the stomach is the use of activated charcoal, an odorless, tasteless, fine black powder that adsorbs many compounds, creating a stable complex. In the future, activated charcoal may replace syrup of ipecac as the home remedy of choice (Ford, 2001), but the AAP believes it is premature to recommend the administration of activated charcoal in the home (Committee on Injury, Violence and Poison Prevention, 2003). Activated charcoal is mixed with water or a saline cathartic to form a slurry. Slurries are neither gritty nor distasteful but resemble black mud. To increase the child’s acceptance of activated charcoal, the nurse should mix it with diet soda and serve it through a straw in an opaque container with a cover (such as a disposable coffee cup and lid) or an ordinary cup covered with aluminum foil or placed inside a small paper bag. Potential complications from the use of activated charcoal include aspiration (usually in patients with impaired gag reflexes), constipation, and intestinal obstruction (in multiple doses). Cathartics, such as sorbitol, sodium, or magnesium, may be administered to stimulate evacuation of the bowel, thus decreasing systemic absorption of the poison and aiding in the removal of the charcoal. Many commercial preparations of activated charcoal contain cathartics. However, the use of cathartics is controversial.
In a minority of poisonings, specific antidotes are available to counteract the poison. They are highly effective and should be available in all emergency facilities. The supply of antidotes should be checked routinely and replaced as used or according to expiration dates. Among the more frequently employed antidotes are N-acetylcysteine for acetaminophen poisoning, oxygen for carbon monoxide inhalation, naloxone for opioid overdose, flumazenil (Romazicon) for benzodiazepine (Valium, Versed) overdose, Digibind for digoxin toxicity, and antivenin for certain poisonous bites.
September 8, 2004