In the treatment of acute poisoning most patients require only supportive and symptomatic therapy. The active removal of poisons from the stomach by gastric lavage or emesis induction may be considered, as should the administration of substances like activated charcoal by mouth to reduce their absorption. However, the use of emetics and gastric lavage has been questioned and these measures, including the administration of charcoal are for instance inappropriate in corrosive poisoning, and aspiration should only be carried out with great care.

Ipecac is used in large doses as an emetic for selected patients. Vomiting usually occurs with in 30 minutes of administration by mouth of an emetic dose due to an irritant effect on the gastro-intestinal tract and a central action on the chemoreceptor trigger zone. Doses are usually followed by a copious drink of water or fruit juice; in young children this may be given before the dose. Many clinicians recommend that activated charcoal be administered after ipecac syrup. Activated charcoal will adsorb syrup of ipecac; therefore, if both measures are to be used, it is imperative to induce vomiting with ipecac before administering activated charcoal is given.

The "Universal antidote" (2 parts activated charcoal, 1 part magnesium oxide, and 1 part tannic acid) is inferiors to activated charcoal alone. In addition, the tannic acid component is potentially hepatotoxic. Thus, there is no justification for the use of the "Universal antidote".

Acetylcysteine

Injection, 200 mg/ml in 10 ml ampoule

Indications: - antidote to Acetaminophen overdose, to protect against hepatotoxicity.

Cautions: - patients with history of asthma, conditions predisposing to gastrointestinal hemorrhage such as esophageal varices, peptic ulceration, and in patients sensitive to acetylcysteine.

Side effects: - drowsiness, fever, nausea, or vomiting, bronchospastic allergic reaction (troubled breathing, tightness in chest, wheezing), skin rash or hives.

Dose and Administration:

Adult and Children: - Antidote - IV, 300mg per kg of body weight administered over twenty and one-fourth hours, divided as follows:

Initial loading dose - 150mg per kg of body weight in up to 200ml of 5% dextrose injection, administered over fifteen minutes.

Second infusion- 50mg per kg of body weight in 500ml of 5% dextrose injection, administered over four hours.

Third infusion - 100mg per kg of body weight in 1000ml of 5% dextrose injection, administered over the next sixteen hours.

Ipecac

Syrup, 7% powdered Ipecac

Indications: - an emetic for emergency use in the treatment of drug overdose and in some cases of poisoning

Cautions: - children under 1 year of age; heart disease active or impending seizures and in conditions of strychnine poisoning or ingestion of petroleum distillates, such as kerosene, gasoline, coal oil, fuel oil, paint thinner, or cleansing fluid.

Drug interactions: - activated charcoal, milk or milk products, carbonated beverages, antiemetics.

Side effects: - diarrhoea, fast or irregular heartbeat, nausea or vomiting, stomach cramps or pain, troubled breathing, unusual tiredness or weakness, aching, and stiffness of muscles, especially those of the neck, arms, and legs.

Contraindications - impending coma, severe inebriation, corrosive poisoning with alkali and strong acids, depressed gag reflex, impending shock states.

Dose and Administration, orally -

Usual Adult and adolescent dose: - emetic-oral, 15 to 30ml followed immediately by one glass (240ml) of water. Dose may be repeated in twenty minutes if emesis does not occur. The dosage should be reversed by gastric lavage if emesis does not occur after the second dose.

Usual child dose - Emetic

Children up to 1 year of age - oral, 5 to 10ml

Children 1-12 years of age - oral, 15ml, preceded or followed by ½-1 full glass (120-240ml) of water.

Storage: - at a temperature below 25°c.

Universal Antidote (charcoal + tannic acid + magnesium oxide)

Powder, 2 parts + 1 part + 1 part

Indications: -treatment of selected cases of acute poisoning to adsorb the toxic substance and thereby reduces its systemic absorption.

Note: The "Universal antidote" is inferiors to activated charcoal alone. In addition, the tannic acid component is potentially hepatotoxic. Thus, there is no justification for the use of the "Universal antidote".