JAWAHARLAL NEHRU TECHNOLOGICAL UNIVERSITY HYDERABAD Pharm. D IV Year CLINICAL TOXICOLOGY Previous Question Paper (October/November - 2019 - R08)

Gut decontamination refers to clinical procedures aimed at reducing the absorption of ingested toxins from the gastrointestinal tract. The choice of method depends on the time since ingestion, the nature of the toxin, and the patient's clinical status.

• Activated Charcoal: The most common method, involving the administration of a fine powder that adsorbs toxins to its surface, preventing systemic absorption. It is most effective when given within one hour of ingestion.
• Gastric Lavage: Involves passing a large-bore orogastric tube to wash out the stomach contents with saline. It is reserved for life-threatening ingestions occurring within 60 minutes and is rarely used due to risks like aspiration and esophageal injury.
• Whole Bowel Irrigation (WBI): Uses large volumes of polyethylene glycol electrolyte solution to flush the entire gastrointestinal tract. It is indicated for ingestions of sustained-release medications, heavy metals (e.g., iron, lead), or body packers.
• Emesis: The use of ipecac syrup to induce vomiting is now largely obsolete due to unpredictable efficacy and risks of aspiration and delayed administration of activated charcoal.

Alcohol poisoning, specifically ethanol toxicity, occurs when blood alcohol concentrations reach levels that cause central nervous system depression, respiratory failure, and metabolic disturbances. Clinical manifestations include confusion, vomiting, seizures, slow breathing, hypothermia, and hypoglycemia.

Management is primarily supportive:

• Airway and Breathing: Ensure a patent airway; intubation may be required if the patient is comatose or has lost protective gag reflexes to prevent aspiration.
• Fluid Resuscitation: Administer intravenous fluids to correct dehydration and hypotension.
• Glucose Management: Check blood glucose levels immediately and administer IV dextrose if hypoglycemia is present, as alcohol inhibits gluconeogenesis.
• Thiamine Administration: Administer parenteral thiamine (Vitamin B1) to prevent Wernicke's encephalopathy in chronic alcoholics.
• Thermoregulation: Provide warming measures for hypothermic patients.
• Hemodialysis: Rarely required for ethanol alone, but considered in severe cases with extreme acid-base disturbances or if co-ingestion of toxic alcohols like methanol or ethylene glycol is suspected.