RT Book, Section
A1 Hoegberg, Lotte C. G.
A1 Gude, Anne-Bolette
A2 Hoffman, Robert S.
A2 Howland, Mary Ann
A2 Lewin, Neal A.
A2 Nelson, Lewis S.
A2 Goldfrank, Lewis R.
SR Print(0)
ID 1108424323
T1 Techniques Used to Prevent Gastrointestinal Absorption
T2 Goldfrank's Toxicologic Emergencies, 10e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071801843
LK accesspharmacy.mhmedical.com/content.aspx?aid=1108424323
RD 2024/04/20
AB Gastrointestinal  (GI)  decontamination  is  a  highly  controversial  issue  in  medical  toxicology.  It  can  play  an  essential  role  in  the  initial  management  of  orally  poisoned  patients  and  frequently  is  the  only  treatment  available  other  than  routine  supportive  care.  Unfortunately,  as  is  true  in  most  areas  of  medical  toxicology,  rigorous  studies  that  demonstrate  the  effects  of  GI  decontamination  on  clinically  meaningful  endpoints  are  difficult  to  find.  The  heterogeneity  of  poisoned  patients  demands  that  very  large  randomized  studies  be  performed  because  patients  who  present  to  an  emergency  department  (ED)  may  have  an  unreliable  history  and  a  low-risk  exposure.31,156  These  factors,  as  well  as  other  significant  sources  of  bias,  are  often  hidden  in  inclusion  and  exclusion  criteria  of  the  available  studies.  Numerous  determinants  contribute  to  the  difficulties  in  designing  and  completing  studies  that  provide  sound  evidence  for  or  against  a  particular  therapeutic  option.  Incontrovertible  endpoints,  such  as  complication-specific  mortality,  also  demand  exceptionally  large  studies  because  the  overall  morbidity  and  mortality  of  poisoned  patients  are  quite  low.31  Whereas  other  endpoints,  such  as  the  length  of  stay  in  the  hospital  or  intensive  care  unit  (ICU),  change  in  xenobiotic  concentration,  the  rate  of  secondary  complications,  and  the  need  for  specific  treatments  such  as  expensive  antidotes,  must  be  considered,  these  surrogate  markers  are  not  adequately  rigorous  and  are  inadequately  precise  measures  of  morbidity.  In  the  science  of  GI  decontamination,  we  are  also  faced  with  the  dilemma  that  randomizing  half  of  a  group  of  potentially  ill  patients  to  no  decontamination  is  a  significant  ethical  concern—we  rarely  omit  decontamination  unless  a  minimally  toxic  exposure  has  occurred  or  an  effective,  safe,  readily  available,  and  inexpensive  antidote  exists.  Because  acetaminophen  (APAP)  meets  many  of  these  parameters,  it  has  been  used  both  as  the  xenobiotic  of  choice  in  volunteer  overdose  ­studies42,82,94,152,239  and  in  the  evaluation  of  actually  poisoned  patients.53  However,  despite  its  widespread  use  as  a  model,  the  applicability  of  the  management  approach  for  APAP  poisoning  to  other  ingestions  is  limited.