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PubMed1996

Combined dapsone and clofazimine intoxication.

We report clinical findings and pharmacokinetic data regarding a combined dapsone and clofazimine intoxication in a man, who ingested 50 tablets of dapsone (100 mg) 20 capsules of clofazimine (100 mg) and two tablets of rifampicin (600 mg). Oral administration of activated charcoal (50 grams) and sodium sulphate (20 grams) after gastric lavage resulted in an elimination half-life in plasma of 11.1 and 10.8 h for dapsone and its main metabolite, monoacetyldapsone, respectively. A rapid initial decrease of the plasma concentration of clofazimine was observed after gastric lavage and administration of activated charcoal and sodium sulphate. 15 h after this treatment, clofazimine plasma levels remained relatively constant. Dapsone-induced methaemoglobinaemia (48% at admission) was treated successfully with methylene blue.

Adult↗

PubMed1998

Acute clozapine overdose: plasma concentration and outcome.

Clozapine is a tricyclic dibenzodiazepine derivative that is classified as an "atypical neuroleptic" drug for treatment of psychotic diseases. A 19-year-old schizophrenic female, treated with 400 mg clozapine per day, was admitted to the emergency department after ingestion of 5000 mg (50 x 100 mg tablets) of clozapine. Clozapine plasma level 2.5 hours after ingestion was 3.8 microg/ml (normal range 0.2-0.7 microg/ml) and very high in gastric lavage. Contrary to reported cases with such high plasma concentrations the patient suffered only from somnolence with intermittent periods of agitation and a mild anticholinergic syndrome with sinus tachycardia and slight hypotension. After detoxication with gastric lavage and short-term administration of pyridostigmine she remained stable, and 24 hours after ingestion she was transferred to the psychiatric unit without further sequelae. To prevent late-onset complications she was carefully monitored for five days. The clozapine plasma level 24 hours after the first measurement was normal. This case and others reported in the literature confirm that signs and symptoms after clozapine intoxication are variable and that high plasma levels are not lethal in every case.

Adult↗

PubMed1982

[Poisoning by spirits of turpentine or turpentine oil. Review of its treatment apropos of a personal case].

Authors deduce from their experience during 1979 that intoxication by spirit oil of turpentine is an accident with few repercussions in infancy, because the quantity ingested does not reach toxic levels, except for children over seven who try to commit suicide. Gastric lavage must not be practiced because removing turpentine can provoke its' aspiration with a consequent pulmonary disease in the majority of occasions. Only when ingestion is more than 1 ml./Kg., or symptoms suggest important disease, can gastric lavage, be done because secondary complications can aggravate the disease. Antibiotics are used if there is an obvious infection, remembering that turpentine intoxication itself can provoke fever. In their experience, corticoids don't modify the evolution.

Age Factors↗

PubMed1982

Management of acute upper gastrointestinal bleeding.

Initial management of acute upper gastrointestinal (UGI) bleeding depends on the clinical status of the patient. Symptoms of reduced blood volume or shock are clear indications for blood transfusion; oxygen therapy also may be needed. A brief history and physical examination, gastric aspiration, and gastric lavage help in ascertaining if bleeding is in the UGI tract; endoscopy, barium x-ray studies, and angiography help to identify the exact site. Bleeding from the most common causes of UGI tract hemorrhage--duodenal and gastric ulcers, esophagitis, and Mallory-Weiss tears--stops spontaneously or with gastric lavage in about 85% of patients. Patients with variceal hemorrhage have a worse prognosis and require intensive care. Vasopressin (Pitressin) infusion, either intravenous or intraarterial, is the first treatment to try. If it is not effective, balloon tamponade, sclerotherapy if available, or surgery may be necessary. Advances in medical, endoscopic, and surgical therapy may reduce morbidity and mortality in the future.

Blood Transfusion↗

PubMed1996

Trends in gastrointestinal decontamination for deliberate self poisoning in Christchurch.

AIM: To examine changes in the choice of gastrointestinal decontamination for deliberate self poisoning in Christchurch. METHOD: A review of adult deliberate self poisoning cases for 9 months from July 1 1995 to March 31 1996 and a comparison with previously published figures from 1989 and 1992. RESULTS: Only 5% of patients received gastric lavage (compared with 26% in 1992 and 78% in 1989) and 52% received activated charcoal (compared with 46% in 1992 and 0.4% in 1989). No patients received syrup of ipecacuanha (compared with 1% in 1992 and 25% in 1989) and 43% had no gastrointestinal decontamination at all. CONCLUSION: The trend towards the use of activated charcoal and away from gastric lavage is consistent with sentiments expressed in the literature.

Adult↗

PubMed1995

The risk of aspiration in Dettol poisoning: a retrospective cohort study.

1. To determine if the risk of aspiration is increased in 'Dettol' (4.8% chloroxylenol, pine oil and isopropyl alcohol) poisoning and the factors that may be responsible, a study was made of 89 patients and 89 matched control subjects with other forms of poisoning admitted to the Prince of Wales Hospital, Hong Kong. 2. Aspiration was more common in patients with Dettol poisoning (8% vs 3%, P = 0.16). There were more control subjects with drowsiness at presentation (54% vs 24%, P < 0.0001), but the use of gastric lavage (88% vs 64%, P < 0.001) and the occurrence of vomiting (62% vs 17%, P < 0.0001) were more common in patients with Dettol poisoning. 3. Our findings suggest that Dettol poisoning may be associated with an increased risk of aspiration. This increase in risk may be related to the use of gastric lavage and the common occurrence of vomiting in patients with Dettol poisoning.

Adolescent↗

PubMed2006

Isolation of non-tuberculous mycobacteria in children investigated for pulmonary tuberculosis.

OBJECTIVE: To evaluate the frequency and clinical significance of non-tuberculous mycobacteria (NTM) isolates among children investigated for pulmonary tuberculosis in a rural South African community. METHODS: Children were investigated for pulmonary tuberculosis as part of a tuberculosis vaccine surveillance program (2001-2005). The clinical features of children in whom NTM were isolated, from induced sputum or gastric lavage, were compared to those with culture-proven M. tuberculosis. RESULTS: Mycobacterial culture demonstrated 114 NTM isolates from 109 of the 1,732 children investigated, a crude yield of 6% (95% CI 5-7). The comparative yield of positive NTM cultures from gastric lavage was 40% (95% CI 31-50), compared to 67% (95% CI 58-76) from induced sputum. 95% of children with NTM isolates were symptomatic. Two children were HIV-infected. By contrast, M. tuberculosis was isolated in 187 children, a crude yield of 11% (95% CI 9-12). Compared to those with culture-proven M. tuberculosis, children with NTM isolates were less likely to demonstrate acid-fast bacilli on direct smear microscopy (OR 0.19; 95% 0.0-0.76). Children with NTM were older (p<0.0001), and more likely to demonstrate constitutional symptoms (p = 0.001), including fever (p = 0.003) and loss of weight or failure to gain weight (p = 0.04), but less likely to demonstrate a strongly positive tuberculin skin test (p<0.0001) or radiological features consistent with pulmonary tuberculosis (p = 0.04). DISCUSSION: NTM were isolated in 6% of all children investigated for pulmonary tuberculosis and in more than one third of those with a positive mycobacterial culture. NTM may complicate the diagnosis of PTB in regions that lack capacity for mycobacterial species identification. The association of NTM isolates with constitutional symptoms suggestive of host recognition requires further investigation.

Gastric Lavage↗

PubMed1984

Noradrenaline in upper gastrointestinal haemorrhage. A prospective, randomized, double blind controlled clinical trial.

The effect of noradrenaline (8 mg in 100 ml cold saline) gastric lavage was compared with that of cold saline alone in 42 patients with upper gastrointestinal haemorrhage in a prospective, randomized, double blind study. Fifty three per cent (11/21) of the patients given noradrenaline stopped bleeding within two hours of treatment compared with 14% (3/21) of those given saline alone. We suggest that noradrenaline gastric lavage is a simple, safe and effective method for controlling upper gastrointestinal haemorrhage and could be used with advantage in peripheral hospitals in tropical countries.

Adolescent↗

PubMed1998

A prospective study of acute poisonings in Finnish hospital patients.

1. We have carried out a prospective study of all adult patients presenting with acute poisoning during one month to the Helsinki University Central Hospital (Meilahti Hospital). 2. Two hundred and twenty-six cases of acute poisoning (113 males and 113 females) presented to the emergency department. Most cases in both men (66%) and women (67%) involved alcohol. As to drugs, psychotropic agents predominated in both men and women. The frequency of patient presentation peaked between 7 p.m. and 9 p.m. and was lowest between 8 a.m. and 10 a.m. In most cases, the delay from ingestion of the poison to presentation was longer than 4 h. 3. The clinical status of the patients on arrival was generally good; more than half (55%) of them were fully awake. Serious symptoms (e.g. unconsciousness, insufficient respiration necessitating intubation, aspiration, convulsions or hypotension) occurred in 15% of the presentations. There were no fatalities. 4. One hundred and thirty-five patients (60%) received at least one 50-g dose of activated charcoal. However, charcoal was given in 86% of the cases of drug poisoning. Gastric lavage was performed in 112 cases (50%), and 106 cases (47%) involved both gastric lavage and administration of charcoal. Twenty-one patients received antidotes (flumazenil, calcium gluconate or naloxone) and three patients were hemodialysed. 5. Of the 226 cases, 142 (63%) were managed solely in the emergency department. Of the 84 cases admitted to the hospital, eight had to be managed in the intensive care unit. Almost all patients (94%) were discharged within 24 h. 6. In this survey on 226 consecutive cases of acute poisoning, about two-thirds of the cases involved alcohol, while the most common drugs taken were psychotropic agents. The poisoning was mild in the great majority of the cases. Activated charcoal was generally administered in all but trivial cases of drug poisoning.

Acute Disease↗

PubMed1998

[Accidental ingestion of cigarettes by children].

Accidental ingestion of cigarettes (and butts) is mainly seen in young children. Nicotine in tobacco products is easily absorbed by the oral mucosa and intestines; absorption depends on nicotine content and pH of tobacco. Symptoms are caused by the nicotine component and usually develop rapidly (< 4 hours). The most common symptom is vomiting. Although cigarettes are potentially toxic, their ingestion by children is generally benign. Decontamination of the mouth with water may be useful. Induction of emesis is not advised. Gastric lavage is not needed in asymptomatic patients (with an unreliable history) or after vomiting. Children who ingested cigarettes should receive medical observation for four hours after ingestion. Children with significant symptoms should be admitted and eventually treated by supportive care. In symptomatic children or children with a reliable history of ingestion of large quantities who have not vomited gastric lavage with administration of activated charcoal has to be performed. When after vomiting other symptoms persist activated charcoal can be given via a nasogastric tube.

Accidents, Home↗

PubMed1999

[What should be done if a patient refuses treatment after self- poisoning?].

Three women aged 28, 30 and 39 years, attending an emergency room because of attempted suicide by means of an overdose of drugs, refused somatic treatment considered necessary: one refused gastric lavage and two refused to remain in the hospital. After explanation of the procedure, one patient left the clinic without treatment and one agreed to admission--both were subsequently treated in the outpatient department. One patient agreed to giving a blood sample, after which she could leave the hospital without risk of somatic complications--two days later she agreed to admission for further treatment. Obligatory gastric lavage after (auto)intoxication is possible under the Medical Treatment Agreement Act (WGBO) and should follow its rules. However, this may be avoided by using a laboratory test or ECG for the diagnosis and administration of activated charcoal and a laxative for the treatment.

Acetaminophen↗

PubMed1995

Clinical effects and management of eucalyptus oil ingestion in infants and young children.

OBJECTIVE: To determine the symptoms and signs of eucalyptus oil poisoning in infants and young children, to estimate the toxic dose and to recommend management strategies. DESIGN AND SETTING: Retrospective analysis of case histories of children admitted to the Royal Children's Hospital, Melbourne, between 1 January 1981 and 31 December 1992 with a diagnosis of eucalyptus oil poisoning. MAIN OUTCOME MEASURES: Demographic data, circumstances of ingestion, doses, clinical effects, management, complications and duration of hospital stay. RESULTS: 109 children (mean age, 23.5 months; range, 0.5-107) were admitted; clinical effects were observed in 59%. Thirty-one (28%) had depression of conscious state; 27 were drowsy, three were unconscious after ingesting known or estimated volumes of between 5 mL and 10 mL, and one was unconscious with hypoventilation after ingesting an estimated 75 mL. Vomiting occurred in 37%, ataxia in 15% and pulmonary disease in 11%. No treatment was given for 12%. Ipecac or oral activated charcoal was given for 21%, nasogastric charcoal for 57%, and gastric lavage without anaesthesia for 4% and under anaesthesia for 6%. All patients recovered. Hazardous treatment and overtreatment were common. For 105 children, mean hospital stay was 22 hours (range, 4-72 h) and for 13 patients mean intensive care unit stay was 18 hours (range, 4-29 h). In 27 patients who ingested known doses of eucalyptus oil, 10 had nil effects after a mean of 1.7 mL, 11 had minor poisoning after a mean of 2.0 mL, five had moderate poisoning after a mean of 2.5 mL and one had major poisoning after 7.5 mL (P = 0.0198). CONCLUSIONS: Ingestion of eucalyptus oil caused significant morbidity in infants and young children. Significant depression of conscious state should be anticipated after ingestion of 5 mL or more of 100% oil. Minor depression of consciousness may occur after 2-3 mL. Airway protection should precede gastric lavage.

Adult↗

PubMed1999

Gastric decontamination--a view for the millennium.

The management of acute poisoning remains an important part of accident and emergency (A&E) care. Three gastric decontamination procedures have been widely used: gastric lavage, ipecac, and activated charcoal. Their role has recently been reviewed and position statements developed by working groups of the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. These have important implications for A&E, as they indicate that activated charcoal is now the agent of choice for most poisons, but than in most situations it is probably only effective if given within an hour of overdose. Ipecac is effectively obsolete and gastric lavage has a narrow range of indications, principally for potentially serious amounts of agents not adsorbed by charcoal. Protocols for care of overdose patients should be modified accordingly.

Acute Disease↗

PubMed2003

Aspiration pneumonia following severe self-poisoning.

PURPOSE: To investigate the risk factors of aspiration pneumonia following severe self-poisoning. MATERIALS AND METHODS: Patients treated due to severe self-poisoning in the ICU of Oulu University Hospital, Oulu, Finland during 1.11.1989-31.10.2000 were analyzed retrospectively. RESULTS: 28.4% of 257 patients fulfilled the criteria of aspiration pneumonia. An unconscious patient who was not intubated until arrival at the emergency room (ER) had an odds ratio (OR) of 3.34 (CI 1.3-8.7) for aspiration pneumonia. If the patient was intubated at the first contact with health care providers, OR was 1.8 (CI 0.6-5.7). The use of gastric lavage or activated charcoal in the case of a non-intubated unconscious patient led to ORs of 2.7 (CI 0.8-9.3) and 3.7 (CI 1.01-12.5), respectively. The mean length of ICU stay was 0.9 (CI 0.8-0.9) days among patients without aspiration pneumonia and 1.9 (CI 1.3-2.6) days among those with aspiration pneumonia. The mean length of hospital stay was 2.8 (CI 2.5-3.1) days among the patients without aspiration pneumonia and 6.5 (CI 5.3-7.6) days among those with aspiration pneumonia. CONCLUSION: To avoid aspiration pneumonia intubation of an unconscious patient on scene before arrival at the ER is recommended. The use of gastric lavage and activated charcoal increase the risk of aspiration pneumonia if the patient is unconscious and not intubated. Aspiration pneumonia significantly prolongs the length of ICU and hospital stay.

Adult↗

PubMed1995

Acute organophosphate poisoning after disulfoton ingestion.

A 75-year-old woman attempted suicide by ingesting a large quantity of granular Di-Syston which is an organophosphate insecticide containing 5% disulfoton (ethylthiometon). On admission, the total plasma phosphorodithioate sulfone concentration (disulfoton and its metabolites, phosphorodithioate sulfoxide and its sulfone) determined by gas chromatography was 1095 ng/mL. After gastric lavage, the concentration gradually decreased to 505 ng/mL. However, it began to increase again 20 h after admission and reached the peak concentration (1322 ng/mL) at 56 h. It was concluded that the secondary elevation of the plasma concentration was due to the prolonged absorption of the organophosphate from the residual granules in the stomach, despite the early gastric lavage. Pralidoxime iodide administration temporarily restored erythrocyte cholinesterase activity to almost normal and inhibited the excessive, delayed reduction of cholinesterase activity. It is recommended that poisoning with the granular form of disulfoton should be treated with repetitive or prolonged gastric and intestinal lavage, charcoal, and a continuous intravenous infusion of pralidoxime iodide in addition to atropine sulfate.

Aged↗

PubMedDate not supplied

[A case of phyto-mucous bezoar of the stomach].

A case of gastric phyto-mucous bezoar++ in an edentulous patient with chronic gastritis is reported. The effective medical treatment consisted of partial gastroscopic bezoar crumbling, gastric lavage with 1% sodium bicarbonate solution, and endoscopic removal of residual bezoar. The pathogenesis, symptoms, and treatment of gastric phytobezoars are discussed.

Aged↗

PubMed1978

Paraquat poisoning: a review.

The pathophysiology, symptoms and treatment of paraquat intoxication, primarily from oral ingestion, and the pharmacology and pharmacokinetics of paraquat are reviewed. Toxicity has occurred after topical application, oral ingestion or inhalation of paraquat. Systemic toxicity has not been reported from smoking of paraquat-contaminated marijuana but heavy abusers of contaminated marijuana may experience coughing, hemoptysis and mouth irritation. Following ingestion of 30 mg/kg or 50 ml of a 21% (w/w) solution of paraquat (as the base), hepatic, cardiac or renal failure or death may occur. Smaller doses (greater than or equal to 4 mg/kg of paraquat base) may cause respiratory distress, renal dysfunction or, occasionally, jaundice or adrenal cortical necrosis. When paraquat ingestion is suspected, the drug should be removed immediately from the gastrointestinal tract by gastric lavage or by whole-gut irrigation. Adsorbents such as Fuller's earth, bentonite or activated charcoal may be used during gastric lavage. Combined use of forced diuresis (with furosemide, mannitol and i.v. dextrose in water or normal saline), hemodialysis or hemoperfusion is recommended until the compound cannot be detected in body fluids or the dialysate. Immediate and effective treatment is necessary to prevent systemic toxicity or death from paraquat intoxication.

Cannabis↗

PubMed2004

Acute poisoning with autumn crocus (Colchicum autumnale L.).

INTRODUCTION: Colchicum autumnale, commonly known as the autumn crocus or meadow saffron, contains the antimitotic colchicine, which binds to tubulin and prevents it forming microtubules that are part of the cytoskeleton in all cells. CASE REPORT: A 71-year-old woman ate a plant she thought to be wild garlic (Allium ursinum). Ten hours later she arrived at the emergency department complaining of nausea, vomiting and watery diarrhea. Ingestion of a poisonous plant was suspected and she was treated with gastric lavage, oral activated charcoal and an infusion of normal saline. Toxicology analysis with gas chromatography and mass spectrometry revealed colchicine in the patient's gastric lavage, blood (5 microg/l) and urine (30 microg/l). She developed arrhythmias, liver failure, pancreatitis, ileus, and bone marrow suppression with pancytopenia. Alopecia began in the third week. Treatment was supportive only. Five months later she had no clinical or laboratory signs of poisoning. DISCUSSION: The patient mistakenly ingested autumn crocus instead of wild garlic because of their great similarity. Colchicine primarily blocks mitosis in tissues with rapid cell turnover; this results in gastroenterocolitis in the first phase of colchicine poisoning, bone marrow hypoplasia with pancytopenia in the second and alopecia in the third, all of which were present in our patient. Colchicine toxicity in tissues without rapid cell turnover caused arrhythmias, acute liver failure and pancreatitis. CONCLUSION: Colchicine poisoning can result in gastroenterocolitis followed by multi-organ dysfunction syndrome. In unexplained gastroenterocolitis after ingestion of wild plants as a salad or spice, especially when wild garlic is mentioned, we should always consider autumn crocus. Diagnosis could be confirmed only by toxicology analyses. Management of colchicine poisoning is restricted to supportive therapy.

Aged↗