Recommended Reading

The following is a partial listing of studies pertaining to decontamination of patients using cathartics, ipecac, whole bowel irrigation, activated charcoal, and gastric lavage.

Cathartics.

Sue YJ, Woolf A. Efficacy of magnesium citrate cathartic in pediatric toxic ingestions. Ann Emerg Med 1994; 24:709-712.

Minocha A, Herold DA, Bruns DE, et al. Effect of activated charcoal in 70% sorbitol in healthy individuals. J Toxicol Clin Toxicol 1984; 22:529-536.

James LP, Nichols MH, King WD. A comparison of cathartics in pediatric ingestions. Pediatrics 1995; 96:235-238.

Vuignier BI, Oderda GM, Gorman RL, et al. Effects of magnesium citrate and clidinium bromide on the excretion of activated charcoal in normal subjects. Ann Pharmacother 1989; 23:26-29.

Activated charcoal.

Merigian KS, Woodward M, Hedges JR, et al. Prospective evaluation of gastric emptying in the self-poisoned patient. Am J Emerg Med 1990; 8:479-483.

Litovitz TL, Smilkstein M, Felberg L, et al. 1996 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1997; 15:447-500.

McFarland AK, Chyka PA. Selection of activated charcoal products for the treatment of poisonings. Ann Pharmacother 1993; 27:358-361.

Neuvonen PJ, Olkkola KT. Oral activated charcoal in the treatment of intoxication. Role of single and repeated doses. Med Toxicol 1988; 3:33-58.

Albertson TE, Derlet RW, Foulke GE, et al. Superiority of activated charcoal alone compared with ipecac and activated charcoal in the treatment of acute toxic ingestions. Ann Emerg Med 1989; 18:56-59.

Kornberg AE, Dolgin J. Pediatric ingestions: Charcoal alone vs. ipecac and charcoal. Ann Emerg Med 1991; 20:648-651.

Bosse GM, Barefoot JA, Pfeifer MP, et al. Concomitant use of activated charcoal and N-acetylcysteine. Ann Emerg Med 1985; 14:568-572.

Ipecac.

Chafee-Bahamon C, Lacouture PG, Lovejoy FH Jr. Risk assessment of ipecac in the home. Pediatrics 1985; 75:1,105-1,109.

Czajka PA, Russell SL. Nonemetic effects of ipecac syrup. Pediatrics 1985; 75:1,101-1,104.

Litovitz TL, Klein-Schwartz W, Oderda GM, et al. Ipecac administration in children younger than 1 year of age. Pediatrics 1985; 76:761-764.

Litovitz TL, Smilkstein M, Felberg L, et al. 1996 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1997; 15:447-500.

• Gastric lavage.

Auerbach PS, Osterloh J, Braun O, et al. Efficacy of gastric emptying: Gastric lavage vs. emesis induced with ipecac. Ann Emerg Med 1986; 15:692-698.

Tandberg D, Diven BG, McLeod JW. Ipecac-induced emesis vs. gastric lavage: A controlled study in normal adults. Am J Emerg Med 1986; 4:205-209.

Young WF, Bivins HG. Evaluation of gastric emptying using radionuclides: Gastric lavage vs. ipecac-induced emesis. Ann Emerg Med 1993; 22:1,423-1,427.

Tenenbein M, Cohen S, Sitar DS. Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute drug overdose. Ann Emerg Med 1987; 16:838-841.

Danel V, Henry JA, Glucksman E. Activated charcoal, emesis, and gastric lavage in aspirin overdose. BMJ 1988; 296:1,507.

Saetta JP, March S, Gaunt ME, et al. Gastric emptying procedures in the self-poisoned patient: Are we forcing gastric content beyond the pylorus? J Roy Soc Med 1991; 84:274-276.

Merigian KS, Woodard M, Hedges JR, et al. Prospective evaluation of gastric emptying in the self-poisoned patient. Am J Emerg Med 1990; 8:479-483.

Whole bowel irrigation.

Mayer AL, Sitar DS, Tenenbein M. Multiple-dose charcoal and whole-bowel irrigation do not increase clearance of absorbed salicylate. Arch Intern Med 1992; 152:393-396.

Olsen KM, Ma FH, Ackerman BH, et al. Low-volume whole bowel irrigation and salicylate absorption: A comparison with ipecac-charcoal. Pharmacotherapy 1993; 13:229-232.

Rosenberg PJ, Livingstone DJ, McLellan BA. Effect of whole-bowel irrigation on the antidotal efficacy of oral activated charcoal. Ann Emerg Med 1988; 17:681-683.

Scharman EJ, Lembersky R, Krenzelok EP. Efficiency of whole bowel irrigation with and without metoclopramide pretreatment. Am J Emerg Med 1994; 12:302-305.

Tenenbein M. Whole bowel irrigation in iron poisoning. J Pediatr 1987; 111:142-145.

Everson GW, Bertaccini EJ, O’Leary J. Use of whole bowel irrigation in an infant following iron overdose. Am J Emerg Med 1991; 9:366-369.

Kaczorowski JM, Wax PM. Five days of whole-bowel irrigation in a case of pediatric iron ingestion. Ann Emerg Med 1996; 27:258-263.

For more information about the Medic Alert form, contact:

Michael Gerardi, MD, FAAP, FACEP, Morristown Memorial Hospital, Department of Emergency Medicine, 100 Madison Ave., Morristown, NJ 07962. Telephone: (973) 971-7972. Fax: (973) 290-7202. E-mail: michael.gerardi @ahsys.org.

Alicia Hugg, MA, RN, MedicAlert Foundation, 2323 Colorado Ave., Turlock, CA 95382. Telephone: (209) 669-4033. Fax: (209) 669-2495. E-mail: Hugg_Alicia@medicalert.org.do. Web site: www.medicalert.org.

Medic Alert forms can be downloaded free of charge from the American College of Emergency Physicians’ Web site (www.acep.org) and the American Academy of Pediatrics’ Web site (www.aap.org). The forms also are available for purchase in packets of 100 from the American Academy of Pediatrics for $19.95 plus $5.50 shipping and handling. To order forms, contact:

American Academy of Pediatrics, Publications Department, P.O. Box 747, Elk Grove, IL 60009-0747. Telephone: (800) 433-9016, Ext. 5898. Fax: (847) 228-1281.