Problemi correnti
Primo intervento nell’avvelenamento: basta con la lavanda?
GASTRIC LAVAGE, EMESIS, AND ACTIVATED CHARCOAL: ARE THEY EFFECTIVE AS ROUTINE MANAGEMENTENT OF POISONED CHILDREN?
MARIA DE GIACOMO
Centro Antiveleni del Policlinico Agostino Gemelli, Università Cattolica di Roma
Ottobre 1997 - pagg. 506 -510
Abstract
Gastric lavage and emesis have been employed
widely in gut decontamination of
poisoned patients, but these procedures
lack clear demonstration of clinical benefit,
at least as a routine treatment. Moreover,
complications and contraindications of these
measures are well documented: laryngospasm,
mechanical injury to the gut, oesophageal
perforation and gastric haemorrhage,
aspiration pnenumonia in comatose
patients, particulary if hydrocarbons
were ingested, hypernatraemia and
water intoxication particulary in children.
Cathartics as well have not shown to reduce
significantly drugs and toxics agents
with a few exceptions (acids, alkalis, ethanol,
methanol, ethylene glycol, iron and
lithium). Comparative studies have indicated
that activated charcoal is better that
either gastric lavage or syrup of hipecacuana
in reducing drug absorption. If no lifethreatening
symptoms are present, the first
measure to be taken is calling an poison
centre for appropriate advice.
Classificazione MeSH
Bibliografia
X, n.17, dicembre 1989.
2. Litovitz TL, Felberg L, Soloway RA et al: 1994 Annual report of the American Association of Poison control centres Toxic esposure Surveillance System. Am J Emerg Med 13, 5, 1995.
3. Proudfoot AT: Abandon gastric lavage in the accidental and emergency department. Arch Emerg Med 2, 65-7, 1984.
4. Underhill TJ, Greene MK, Dove AF: A comparison of the efficacy of gastric lavage, ipecacuanha and actived charcoal in the emergency management of paracetamol overdose. Arch Emerg Med 7, 148-154, 1990.
5. Matthew H, Mackintosh TF, Tompsett SL, Cameron JC: Gastric aspiration and lavage, in acute poisoning. BMJ 1, 1333-7, 1966.
6. Watson WA, Leighton J, Guy J, Bergman R, Garriot JC: Recovery of cyclic antidepressants with gastric lavage. J Emerg Med 7, 373- 7, 1961.
7. Allan BC: The role of gastric lavage in the treatment of patients suffering from barbiturate overdose. Med J Australia 2, 513-4, 1961.
8. Writh JT: The value of barbiturate estimations in the diagnosis and treatment of barbiturate intoxication. Quaterly J of Med 24, 95- 108, 1955.
9. Comstock EC, Faulkner TP, Boisaubin EV, Olson DA, Comstock BS: Studies on the efficacy of gastric lavage as practiced in a large metropolitan hospital. Clin Toxic 18, 581-597, 1981.
10. Kulig K, Bar-Or D, Cantrill SV, Rosen P, Rumack BH: Management of acutely poisoned patients without gastric emptying. Ann Emerg Med 14, 562-7, 1985.
11. Justiniani FR, Hippalgaonkar R, Martinez LO: Charcoal-containing empyema complicating treatment for overdose. Chest 87, 404-5, 1985.
12. Wald P, Stern J, Weiner B, Golfrank L: Esophageal tear following forceful removal of an impacted oral-gastric lavage tube. Ann of Emerg Med 15, 80-2, 1986.
13. Harstad E, Moller KO, Simesen MH: Uber den wert del magenspulung bei der behandlung von akuten vergiftungen. Acta Med Scand 112, 478-514, 1942.
14. Spray SB, Zuidema GD, Cameron JL: Aspiration pneumonia: incidence of aspiration with endotracheal tubes. Am J Surg 131, 701-3, 1976.
15. Thompson AM, Robins JB, Prescott LF: Changes in cardiorespiratory function during gastric lavage for drug overdose. Human Tox 6, 215-8, 1987.
16. Leclerc F, Martin V, Gaudier B: Intoxication par l’eau secondaire au lavage d’estomac. Nouv Presse Méd 10, 1149-50, 1981.
17. Neuvonen PJ, Vartiainen M, Tokola O: Comparison of activated charcoal and ipecac syrup in prevention of drug absorption. Eur J Clin Pharmacol 24, 557-62, 1983.
18. Curtis RA, Barone J, Giacona N: Efficacy of ipecac and activated charcoal/cathartic: prevention of salicylate absorption in simulated overdose. Archiv of Intern Med 144, 48-52, 1984.
19. Pond SM, Lewis-Driver DJ, Williams GM, Green AC, Stevenson NW: Gastric emptying in acute overdose: a prospective randomized control trial. Br Med J 163, 345-9, 1995.
20. Tenenbein M, Cohen S, Sitar DS: Efficacy of ipecac-induced emesis, and gastric lavage in aspirine overdose. Ann Emerg Med 16, 838- 41, 1987.
21. Neuvonen PJ, Elfving SM, Elonen E: Reduction of absorption of digoxin, phenytoin and aspirin by activated charcoal in man. Eur J Pharm 13, 213-8, 1978.
22. Neuvonen PJ, ELonen E: Effect of activated charcoal on absorption and elimination of phenobarbital, carbamazepine and phenylbutazone in man. Eur J Clin Pharmacol 17, 51-7, 1980.
23. El-Bahie N, Allen EM, Williams J, Routledge PA: The effect of activated charcoal and hyoscine butylbromide alone and in combination on the absorption of mefanamic acid. Brit J Clin Pharmacol 19, 836-8, 1985.
24. McNamara RM, Aaron CK, Gemborys M, Davidheiser S: Sorbitol catharsis does not enhance efficacy of charcoal in a simulated acetaminophen overdose. Ann Emerg Med 17, 243-6, 1988.
25. Lim DT, Sing P, Nourtsis S, Cruz RD: Absorption inhibition and enhancement of elimination of sustained-release theophylline tablets by oral activated charcoal. Ann Emerg Med 15, 1303-7, 1986.
26. Neuvonen PJ, Oikkola KT: Activated charcoal and syrup of ipecac in prevention of cimetidine and pindolol absorption in man after administration of metaclopramide as an antiematic agent. Clin Toxicol 22, 103, 1984.
27. Cordonnier J, Ven Den Heede M, Heyndrickx A: Activated charcoal and ipecac syrup in prevention of tilidine absorption in man. Vet Human Toxicol 29, suppl. 2, 105-6, 1987.
28. Goldberg MJ, Spector R, Park GD, Johnson GF, Roberts P: The effect of sorbitol combined with activated charcoal on serum theophylline concentrations after slow-release theophylline. Clin Pharmacol Therap 41, 108-111, 1987.
29. Keller RE, Schwab RA, Krezelok EP: Contribution of sorbitol combined with activated charcoal in prevention of salicylate absorption. Ann Emerg Med 19, 654-6, 1990.
2. Litovitz TL, Felberg L, Soloway RA et al: 1994 Annual report of the American Association of Poison control centres Toxic esposure Surveillance System. Am J Emerg Med 13, 5, 1995.
3. Proudfoot AT: Abandon gastric lavage in the accidental and emergency department. Arch Emerg Med 2, 65-7, 1984.
4. Underhill TJ, Greene MK, Dove AF: A comparison of the efficacy of gastric lavage, ipecacuanha and actived charcoal in the emergency management of paracetamol overdose. Arch Emerg Med 7, 148-154, 1990.
5. Matthew H, Mackintosh TF, Tompsett SL, Cameron JC: Gastric aspiration and lavage, in acute poisoning. BMJ 1, 1333-7, 1966.
6. Watson WA, Leighton J, Guy J, Bergman R, Garriot JC: Recovery of cyclic antidepressants with gastric lavage. J Emerg Med 7, 373- 7, 1961.
7. Allan BC: The role of gastric lavage in the treatment of patients suffering from barbiturate overdose. Med J Australia 2, 513-4, 1961.
8. Writh JT: The value of barbiturate estimations in the diagnosis and treatment of barbiturate intoxication. Quaterly J of Med 24, 95- 108, 1955.
9. Comstock EC, Faulkner TP, Boisaubin EV, Olson DA, Comstock BS: Studies on the efficacy of gastric lavage as practiced in a large metropolitan hospital. Clin Toxic 18, 581-597, 1981.
10. Kulig K, Bar-Or D, Cantrill SV, Rosen P, Rumack BH: Management of acutely poisoned patients without gastric emptying. Ann Emerg Med 14, 562-7, 1985.
11. Justiniani FR, Hippalgaonkar R, Martinez LO: Charcoal-containing empyema complicating treatment for overdose. Chest 87, 404-5, 1985.
12. Wald P, Stern J, Weiner B, Golfrank L: Esophageal tear following forceful removal of an impacted oral-gastric lavage tube. Ann of Emerg Med 15, 80-2, 1986.
13. Harstad E, Moller KO, Simesen MH: Uber den wert del magenspulung bei der behandlung von akuten vergiftungen. Acta Med Scand 112, 478-514, 1942.
14. Spray SB, Zuidema GD, Cameron JL: Aspiration pneumonia: incidence of aspiration with endotracheal tubes. Am J Surg 131, 701-3, 1976.
15. Thompson AM, Robins JB, Prescott LF: Changes in cardiorespiratory function during gastric lavage for drug overdose. Human Tox 6, 215-8, 1987.
16. Leclerc F, Martin V, Gaudier B: Intoxication par l’eau secondaire au lavage d’estomac. Nouv Presse Méd 10, 1149-50, 1981.
17. Neuvonen PJ, Vartiainen M, Tokola O: Comparison of activated charcoal and ipecac syrup in prevention of drug absorption. Eur J Clin Pharmacol 24, 557-62, 1983.
18. Curtis RA, Barone J, Giacona N: Efficacy of ipecac and activated charcoal/cathartic: prevention of salicylate absorption in simulated overdose. Archiv of Intern Med 144, 48-52, 1984.
19. Pond SM, Lewis-Driver DJ, Williams GM, Green AC, Stevenson NW: Gastric emptying in acute overdose: a prospective randomized control trial. Br Med J 163, 345-9, 1995.
20. Tenenbein M, Cohen S, Sitar DS: Efficacy of ipecac-induced emesis, and gastric lavage in aspirine overdose. Ann Emerg Med 16, 838- 41, 1987.
21. Neuvonen PJ, Elfving SM, Elonen E: Reduction of absorption of digoxin, phenytoin and aspirin by activated charcoal in man. Eur J Pharm 13, 213-8, 1978.
22. Neuvonen PJ, ELonen E: Effect of activated charcoal on absorption and elimination of phenobarbital, carbamazepine and phenylbutazone in man. Eur J Clin Pharmacol 17, 51-7, 1980.
23. El-Bahie N, Allen EM, Williams J, Routledge PA: The effect of activated charcoal and hyoscine butylbromide alone and in combination on the absorption of mefanamic acid. Brit J Clin Pharmacol 19, 836-8, 1985.
24. McNamara RM, Aaron CK, Gemborys M, Davidheiser S: Sorbitol catharsis does not enhance efficacy of charcoal in a simulated acetaminophen overdose. Ann Emerg Med 17, 243-6, 1988.
25. Lim DT, Sing P, Nourtsis S, Cruz RD: Absorption inhibition and enhancement of elimination of sustained-release theophylline tablets by oral activated charcoal. Ann Emerg Med 15, 1303-7, 1986.
26. Neuvonen PJ, Oikkola KT: Activated charcoal and syrup of ipecac in prevention of cimetidine and pindolol absorption in man after administration of metaclopramide as an antiematic agent. Clin Toxicol 22, 103, 1984.
27. Cordonnier J, Ven Den Heede M, Heyndrickx A: Activated charcoal and ipecac syrup in prevention of tilidine absorption in man. Vet Human Toxicol 29, suppl. 2, 105-6, 1987.
28. Goldberg MJ, Spector R, Park GD, Johnson GF, Roberts P: The effect of sorbitol combined with activated charcoal on serum theophylline concentrations after slow-release theophylline. Clin Pharmacol Therap 41, 108-111, 1987.
29. Keller RE, Schwab RA, Krezelok EP: Contribution of sorbitol combined with activated charcoal in prevention of salicylate absorption. Ann Emerg Med 19, 654-6, 1990.