Hemodialysis or exchange transfusions may be indicated to remove a drug/toxin. Recommended rates: 9 months to 6 years (500 mL/hr), 6 to 12 years (1000 mL/hr), more than 12 years (1500 to 2000 mL/hr). Use a polyethylene glycol electrolyte solution preparation to irrigate the bowel. Indicated for evacuation of substances not bound to activated charcoal such as iron, lead-containing foreign bodies, fatal sustained release products, drug packing. Contraindications: Unprotected airway, caustic ingestion, disrupted gastrointestinal tract, concern for aspiration Substances not absorbed by charcoal: Iron, alcohols, lithium Nasogastric (NG)tube should be used only if a patient is intubated. Should be given PO to an awake and alert patient. Most effective when used within first hour after ingestion but can be given after first hour, especially for sustained-release preparations. Positive results are presumptive only must be confirmed by gas chromatography/mass spectrometry. Basic screens include amphetamines, cocaine, opiates, phencyclidine (PCP), and tetrahydrocannabinol (THC). Venous blood gas, blood glucose, and serum electrolytes. Acetaminophen is detected in 1/500 of all suicidal ingestions even when it is not reported as an ingested agent. Acetaminophen levels are especially important to test in suicidal ingestions. Individual drug levels such as acetaminophen, aspirin, and ethanol are helpful general screenings in an acute, unknown ingestion. Electrocardiogram (ECG): Several medications will cause ECG changes, including QRS prolongation. Environmental information Accessible items in the house or garage open containers spilled tablets household members taking medications, visitors to the house, herbs, or other complementary medicines. Poison control can assist with pill identification. Attempt to estimate the missing volume of liquid or the number of missing pills from a container.
Substance identification and quantity ingested Attempt to identify exact name of substance(s) ingested, including: product name, active ingredients, possible contaminants, expiration date, concentration, and dose. Route, timing, and number of exposures (acute, chronic, or repeated ingestion), prior treatments or decontamination efforts.
Exposure history Obtain history from witnesses and/or close contacts.
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