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the return is clear. Like induced emesis, gastric lavage’s efficacy in reducing drug
absorption has been reviewed critically; the efficacy has been highly variable and
lavage has not demonstrated improved outcomes in poisoned patients. Several
important risks are associated with gastric lavage, including oxygen desaturation,
aspiration, and mechanical trauma to the oropharynx and esophagus. Gastric
lavage is thus rarely recommended but might be considered for patients
presenting very early after very dangerous ingestions (of toxicants such as
colchicine or arsenic). Contraindications to the procedure include caustic or
corrosive ingestions, impending loss of airway protection, and the presence of
cardiac arrhythmia.
Activated Charcoal. Activated charcoal minimizes absorption of drugs by
adsorbing them onto its large surface area. Charcoal administration has become
the decontamination strategy of choice to prevent pediatric poisoning after
toxicant ingestion and is most effective when used in the first hour after ingestion.
Therefore, if activated charcoal is considered as a treatment option, quick triage
of an exposed patient may be necessary to allow charcoal administration in a
timely fashion. A number of important compounds, such as iron and lithium, do
not adsorb well to activated charcoal ( Table 102.9 ). The usual dose of activated
charcoal is 1 g/kg; adolescents and adults should receive 50 to 100 g. Most
activated charcoal is now available premixed with water to make slurry that can
be taken orally or administered by NG tube. Simply adding soda or another
nonparticulate flavoring agent to the charcoal can improve palatability.
TABLE 102.9
SUBSTANCES POORLY (OR NOT) ADSORBED BY ACTIVATED
CHARCOAL
Common electrolytes
Metals—iron, lead, arsenic, lithium
Mineral acids or bases
Alcohols
Cyanide
Most solvents

Most water-insoluble compounds (e.g., hydrocarbons)