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What is activated charcoal efficacy dependent on?
Time after ingestion of toxin
How long stays in GI tract
Toxin-AC can start to desorb after 30 min
Toxin to AC ratio
1:10 ratio optimal
Stomach contents
Quality of AC product
Many products contain AC
Be sure to use MEDICAL GRADE AC
What are the other ingredients prepared activated charcoal formulations may have?
sorbitol = cathartic
kaolin = clay absorbent
propylene glycol
glycerol = carrier, stabilizer
In clinic, you should be sure to have some activated charcoal on hand without a _______.
cathartic
True or false: it is never too late to give activated charcoal as long as any toxin remains in GI tract
true
How does AC enhance elimination?
decreasing enterohepatic recylcing
What are the pros and cons of giving activated charcoal before inducing emesis?
pros:
starts binding toxin right away
increases contents in stomach, improves emesis
cons:
cannot use vomit or lavage for analysis
must repeat after emesis or lavage is complete
What are the benefits of using activated charcoal after emesis or lavage?
less toxin to bind up all available sites on AC
vomit or lavage fluid can be used for analysis
What clinical pathology is associated with activated charcoal adminstration?
hypernatremia
What are the absorbing agents other than activated charcoal?
• Kaolin
• Pectin
• Bentonite
• Bismuth
• Ion exchange resins (cholestryramine, others)
• Products sold as “mycotoxin binders”
What is the major goal of enhancing elimination?
• To remove as rapidly as possible any toxin that has ALREADY BEEN ABSORBED into the systemic circulation and tissues
• To diminish degree and duration of toxic effects
What are the major methods of enhancing elimination?
diuresis (urinary excretion)
decrease enterohepatic recycling (biliary excretion) → multiple doses of activated charcoal
What are moxidectin, ivermectin, and lipophilic drugs used for?
IV lipid emulsion treatment to enhance elimination
What is the role of systemic chelators?
enhances elimination of absorbed toxin by altering diffusion gradient (ex. metal chelators used for various metal poisons)
What is an antidote?
an agent that reacts with the poison or its receptor or interferes with its metabolite pathway to decrease the ability of the poison to cause toxicity
How do antidotes treat toxicities?
block receptors used by the toxin or inhibit metabolism of original substance to a toxic metabolite