General Treatment of Ingested Drugs

One thing that has evolved a lot in medicine is the general treatment of drug overdoses. 

Early in my nursing career, I worked in a community ER. In this setting we saw both adult and pediatric patients. One day, three young boys were brought in after they’d gotten into grandma’s medicine cabinet and sampled a multitude of pills. 

In those days, if the ingestion was within one hour, we did use Syrup of Ipecac to induce vomiting and each of these boys got a dose and a big bucket. Syrup of Ipecac is more effective the more water you drink. All three children were lined up next to one another, each on their own gurney, and I walked down the line encouraging each of them of drink. 
Soon enough, one of them began to vomit. One of the other boys proclaimed that wasn’t going to happen to him and I simply gave him another glass of water to drink. After he saw his second sibling throw up, he said to me, “I don’t want any more water.” 
That didn’t keep him from the invetible. 
What we learned is that causing patient’s to throw up increased their risk of more serious complications– like aspiration pneumonia. It is a risk that while vomiting, you’ll inhale some of that material. 
Then there was “stomach pumping.” There’s a lot of confusion about what this actually is and the last time I did it was over twenty years ago. A large (literally garden size hose) is inserted down the patient’s mouth into their stomach and then, through a pumping action, the stomach contents are washed out with large amounts of saline.
The problem with this therapy became the electrolyte shifts that can happen when replacing stomach contents with saline and this practice has been largely abandoned as well. Also, having a large tube put down into your stomach also increases your risk for vomiting and the same risk discussed above still applies.

What has remained is the use of activated charcoal. Activated charcoal literally looks like ground up charcoal. It is a thick, sludge like material that is sweetened to make is more palatable. In kids– we usually put it in a covered up Styrofoam cup so they can’t see it. If they won’t initially drink it we may flavor it with chocolate milk. The problem becomes that whatever it is diluted in they have to drink all of in order to get the full dose.

Activated charcoal works by binding the drug to make it inactive. If the effects of the drug would be more detrimental to the patient (versus just observing and offering symptomatic support) then we’ll generally try to give it if the patient comes in within one hour of the overdose.

With any ingestions, we usually follow the direction of our Poison Control Center.

If your child has ingested anything of concern, I highly recommend you call them first at 1-800-222-1222.  

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