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

Gut decontamination is a clinical strategy used to reduce the absorption of ingested toxins from the gastrointestinal tract. The choice of method depends on the time elapsed since ingestion, the nature of the toxin, and the patient's clinical status.

• Activated Charcoal: The most common method, administered orally or via nasogastric tube. It adsorbs toxins to its surface, preventing systemic absorption. It is most effective when given within one hour of ingestion.
• Gastric Lavage: Involves mechanical irrigation of the stomach using a large-bore orogastric tube. It is generally reserved for patients who have ingested life-threatening amounts of toxins and present within one hour of ingestion, provided the airway is protected.
• Whole Bowel Irrigation (WBI): Uses large volumes of polyethylene glycol-electrolyte solution to flush the entire gastrointestinal tract. It is indicated for the ingestion of sustained-release or enteric-coated drugs, heavy metals (like iron or lead), or body packers.
• Emesis: Induced vomiting using ipecac syrup is now largely obsolete due to the risk of aspiration and potential for delaying the 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 features include confusion, vomiting, seizures, slow breathing, hypothermia, and hypoglycemia.

Treatment is primarily supportive:

• Airway Management: Ensure a patent airway; intubation may be required if the patient is comatose or has lost protective gag reflexes.
• Fluid Resuscitation: Administer intravenous fluids to treat dehydration and hypotension.
• Glucose Administration: Check blood glucose levels and administer intravenous dextrose if hypoglycemia is present, as alcohol inhibits gluconeogenesis.
• Thiamine Supplementation: Administer parenteral thiamine (Vitamin B1) to prevent or treat Wernicke's encephalopathy, especially in chronic alcohol users.
• Electrolyte Correction: Monitor and correct electrolyte imbalances, particularly magnesium, potassium, and phosphate.
• Hemodialysis: Rarely required for ethanol poisoning unless there is severe, refractory acidosis or concurrent ingestion of other toxic alcohols like methanol or ethylene glycol.