Digestive purification

There exist several digestive methods of purification :

caused Vomiting,
gastric Washing,
Absorption of toxic substances by Activated carbon,
Acceleration of the intestinal transit time.

These methods are in general intended to treat the intoxications by absorptions of toxic substances.

Digestive purification is practiced in complement of the usual treatments (treatments of the known symptoms of the intoxication) and of the possible catch of antidotes… and if there are no counter-indications (see Liste of the counter-indications below).

Preferences of treatment following the state of the patient

Case of the conscious patient

if the introduced substance is not very toxic, one will recommend the activated carbon.
if the introduced substance is strongly toxic,

if the patient is dealt with less than one hour after the intoxication, one will recommend the caused vomiting then the absorption of activated carbon.
at the end of one hour, one will recommend only the activated carbon.
in the case of an absorption of an organic toxin (paraquat, Colchicine,…), gastric washing will be recommended.

Case of the unconscious patient

if the introduced substance is strongly toxic, the patient will be intubé with an inflated small baloon, then one will practice, on this patient, digestive purification.
if the patient introduced a strong amount of Benzodiazépine S, one will manage activated carbon to him, by preventing that the patient absorbs the powder of the activated carbon by the respiratory tracts.

Various methods

Use of the activated carbon

The activated carbon or activated carbon (officinal or commercial activated carbon) is recommended in all the intoxications by ingestion of drugs.

The complications are rare.

It should be prevented that the activated carbon is inhaled at the time of its administration (by oral way). This is why if the patient is unconscious, one will not cease supervising it during the administration of the activated carbon.

The constipation frequently arrives after the treatment.

It is necessary to also pay attention to the risks of obstruction or obstruction of the bowels, in the event of repeated administrations, in the cases of intoxications by drugs slowing down the intestinal transit time (such as Tricyclique S, Neuroleptique S and Atropinique S), and/or in the presence of any disease causing a deceleration of the intestinal transit time.

Coal is diluted in water. The patient will slowly drink the mixture of coal and water, to prevent that he vomits. The patient must absorb an amount ten times higher than the amount of absorptive toxic substance. At a intubé patient, coal can be managed by a gastric probe.

The majority of toxic substances are absorbable by the activated carbon: Antidepressant S, tricyclic, Chloroquine, paraquat, Barbiturate S, colchicine, Phénothiazine S, Benzodiazepine S, digitalic, Salicylated S, Beat-blocking S, Méprobamate, Theophylline, Carbamazépine, Paracetamol etc

Gastric washing

One recommends it in hospital medium for the intoxications by strongly toxic products. One often associates it with the activated carbon when one deals with toxic substance absorptive by oral way.

Caused vomiting

One practices this method for very toxic products, if the ingestion of the poison took place right in the hour previous the treatment and the care. The doctor, who will practice this method, will generally resort to a Vomitif (the such syrup of Ipeca…), to cause the vomiting. If no vomiting arrives 20 minutes after ingestion, the operation again is repeated.

If patient is immediately taken in load, just after absorbed substance very toxic (in the minutes which follows the absorption of the very toxic substance), the doctor will be able if not to make then him an injection of Apomorphine.

In the absence of any vomitory (when one is far from any doctor, of any pharmacy and any medical center), one can sometimes resort to the Household soap, like vomitory.

Acceleration of the intestinal transit time

The acceleration of the intestinal transit time can be obtained by the ingestion of Sorbitol or by intestinal Irrigation continuous using a solution of Polyéthylène glycol. The sorbitol makes it possible to prevent the constipation caused by the activated carbon, if it were managed with repeated amounts.

If not, the recourse to polyethylene glycol is in general exceptional, only in the case of intoxications seen tardily or massive, by nonabsorbable very toxic products by the Activated carbon.

Against indications with digestive purification

There exist counter-indications with the whole of the methods of digestive purification:

in the event of serious intoxications by caustic substances, Hydrocarbon S, foaming products.
when the patient is neither conscious, nor intubé,
when the patient is likely to inhale substances (antidote, activated carbon…), given by the doctor (continuation, for example, with convulsions of this last…)
in the event of problems flow, pressure, speed of blood (except for the case of the activated carbon)
in the event of problem of flow or obstruction of the bowels (paralytic Iléus,… except for the case of gastric washing).

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