Charcoal drugs removed

Basic and advanced life-support measures should be implemented as necessary. In patients presenting within Ih of ingestion, activated charcoal should be administered. In the event of depressed consciousness or seizures, airway protection should first be secured. Sodium bicarbonate, epinephrine, and high-dose diazepam should be used to treat cardiotoxicity. Diazepam is recommended for the treatment of seizures. Methods of extracorporeal drug removal, such as hemoperfusion and hemodialysis, are ineffective. 

TABLE Ml. SOME DRUGS REMOVED BY REPEAT-DOSE ACTIVATED CHARCOAL ... 

D. Enhanced elimination. Symptoms usually abate within several hours and can be managed effectively with intensive supportive care, so there is little to be gained from accelerated drug removal by dialysis or hemoperfusion. The use of repeat-dose activated charcoal has not been studied. 

D. Enhanced elimination. There is no clinical experience with extracorporeal drug removal for these agents. Terazosin and doxazosin are long-acting and eliminated 60% in feces thus, repeat-dose activated charcoal may enhance their elimination. 

The nurse monitors the patient for signs and symptoms of acute salicylate toxicity or salicylism (see Display 17-1). Initial treatment includes induction of emesis or gastric lavage to remove any unabsorbed drug from the stomach. Activated charcoal diminishes salicylate absorption if given within 2 hours of ingestion. Further therapy is supportive (reduce hyperthermia and treat severe convulsions with diazepam). Hemodialysis is effective in removing Hie salicylate but is used only in patients with severe salicylism. 

Hemoperfusion is like hemodialysis except that blood is circulated extracorporeally through a column with adsorbent material like resin or charcoal, which binds molecules electrostatically. The molecules likely to be removed are characterized as poorly dialyzable, lipid-soluble, protein bound. Among the indications for hemoperfusion in the management of poisoning include the presence of a poison in a patient with impairment of excretory system (i.e. damaged kidneys), intoxication of a drug known to produce delayed toxicity or metabolized to a more toxic metabolite (i.e. paraquat or methotrexate), deterioration of the clinical state of the poisoned patient despite conservative therapy (i.e. convulsions or cardiac arrhythmias following theophylline intoxication), or development of coma as a complication. 

Gastric lavage to remove unabsorbed drug. Emesis can be produced by apomorphine and activated charcoal is administered to adsorb the unabsorbed drug. 

Hemoperfusion The process by which a drug is removed from the blood of a poisoned patient by allowing it to be absorbed by activated charcoal or a resin while the blood is pumped through a special machine. 

Kawasaki Cl, Nishi R, Uekihara S, et al. Howtightly can a drug be bound to a protein and still be removable by charcoal hemoperfusion in overdose cases Clin Toxicol. 2005 43 95-99... 

Liver. The liver performs a wide variety of chemical reactions in the body and is the main locus of detoxification. Successful liver transplantation is somewhat rare, and no true artificial liver seems likely in the near future. The process of hemoperfusion, which is sometimes termed an artificial liver, can be used to supplement or relieve the normal liver functions for short time periods. In this technique, the patient s blood is passed through a column or bed of some sorbent material that removes toxic chemicals from the blood. This technique is often used in cases of drug overdose, poisoning, and acute hepatitis. The sorbent material can be charcoal, ion-exchange resins, immobilized hepatic material, or liver material enclosed in artificial cells (microcapsules, usually made from a polyamide). The column is usually a plastic material, and plastic tubing is used to direct the blood flow to and from the device ( 1, 57, M). 

Overdose with phencyclidine is dangerous. The basic principles of treatment are to maintain ventilation and to control seizures, blood pressure, and hyperthermia. Phencyclidine is secreted into the stomach, so removal of the drug may be hastened by activated charcoal or continual nasogastric suction. Phencyclidine is a weak base, and its renal elimination may be accelerated by urinary acidification. Treatment with antipsychotic drugs may be appropriate if psychotic symptoms follow the acute intoxication. The answer is (E). 

The liver Is the main detoxification organ in the body and therefore comes Into contact with nearly every poison and toxin that enters the body. These materials could occur in case of poisoning, drug overdose, acute hepatitis, and allergies. While no true artificial liver has been developed, and transplantation is rare and difficult, several approaches have been attempted to replace and/or assist the function of the liver. The most common method is hemoperfusion in which the blood is passed through a column or bed of some sorbent material which can remove the poisons. The sorbents that have been used include charcoal, ion-exchange resins, affinity chromatography resins, immobilized enzymes and hepatic material or pieces of liver enclosed in artificial cells (9, 52). 

B. Repeated doses of activated charcoal may be indicated to enhance elimination of some drugs if (1) more rapid elimination will benefit the patient (and the benefits outweigh the risks of repeated doses see IV.C and V.C, below), and (2) more aggressive means of removal (eg, hemodialysis orhemoperfu-sion) are not immediately indicated or available (see p 57). However, it has not been proven to improve patient outcome in clinical studies. 

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