The Experts below are selected from a list of 246 Experts worldwide ranked by ideXlab platform
Richard F Clark - One of the best experts on this subject based on the ideXlab platform.
-
polyethylene glycol electrolyte lavage solution increases tablet dissolution of acetaminophen in an in vitro model mimicking acute poisoning
American Journal of Emergency Medicine, 2020Co-Authors: Kimberly Won, Sean Patrick Nordt, Christian Tomaszweski, Richard F ClarkAbstract:Abstract Introduction Polyethylene glycol electrolyte lavage solution (PEG-ELS) is similar to pharmaceutical solvent propylene glycol and used following acute poisonings for Whole Bowel Irrigation (e.g., “body stuffing”). This raises concern of PEG-ELS increasing solubility following acute ingestions of non-sustained release xenobiotics in the stomach. We theorized PEG-ELS increases solubility of acetaminophen in an in vitro stomach model. Material and methods An in vitro artificial stomach with 500 mL simulated gastric fluid and either 500 mL of sodium chloride 0.9% (group A) or 500 mL of PEG-ELS (group B). Ten non-sustained release acetaminophen tablets added with concentrations 0, 15, 45 and 90 min in triplicate. Mean concentrations and mean area under the curve (AUC) (mg-min/L to 90 min). Results In control group A (normal saline + simulated gastric fluid) mean acetaminophen concentrations 0, 3, 13 and 36 mg/L at 0, 15, 45 and 90 min, respectively. In group B (PEG-ELS + simulated gastric fluid) mean acetaminophen concentrations 0, 34, 109 and 136 mg/L at 0, 15, 45 and 90 min, respectively (p Discussion Group B (PEG-ELS) with significantly higher mean acetaminophen concentrations and greater mean AUC compared to control group A (normal saline). Conclusion We demonstrated increased mean acetaminophen concentrations and increased mean AUC of following exposure of PEG-ELS in an artificial stomach model.
-
effect of Whole Bowel Irrigation on the pharmacokinetics of an acetaminophen formulation and progression of radiopaque markers through the gastrointestinal tract
Annals of Emergency Medicine, 2004Co-Authors: Aaron B Schneir, Richard F ClarkAbstract:Abstract Study objectives We describe the effects of Whole Bowel Irrigation on a delayed-release acetaminophen preparation. We compare the mechanical effect of Whole Bowel Irrigation on the progression of radiopaque markers through the gastrointestinal tract between an experimental and a control group. Methods We performed a 2-armed, prospective, randomized, crossover volunteer study. In the experimental phase, subjects were administered a delayed-release acetaminophen preparation (75 mg/kg) along with a capsule containing radiopaque markers. We initiated Whole Bowel Irrigation at 30 minutes after ingestion and continued until the rectal effluent was clear. Serum acetaminophen concentrations were measured at baseline and from 0.5 to 8 hours. Abdominal radiographs were obtained at the completion of Whole Bowel Irrigation. In the control phase, Whole Bowel Irrigation was not performed. The primary outcome measure was the effect on the area under the acetaminophen concentration versus time curve (AUC) between the 2 groups. Results Ten subjects participated in the study. We found an 11.5% reduction in the AUC, with the majority of the effect occurring in the delayed-release portion of the curve after the 2-hour mark. This reduction, however, was not statistically significant. Radiographs obtained at the end of Whole Bowel Irrigation revealed radiopaque markers sequestered in the right hemicolon in 8 of 10 subjects. No discernible pattern was noted in the control arm. Conclusion The effect of Whole Bowel Irrigation on reduction of AUC for delayed-release acetaminophen preparation was not statistically significant. Whole Bowel Irrigation did appear to have a mechanical effect on the progression of radiopaque markers through the gastrointestinal tract, but the clinical significance of this finding is not clear.
-
mercuric oxide poisoning treated with Whole Bowel Irrigation and chelation therapy
Annals of Emergency Medicine, 2002Co-Authors: Binh T Ly, Saralyn R Williams, Richard F ClarkAbstract:Abstract Most reported cases of inorganic mercury poisoning are from mercuric chloride. We report a case of mercuric oxide (HgO) powder ingestion. A 31-year-old man presented to an emergency department after ingestion of approximately 40 g of HgO. Soon after ingestion, he developed nausea, vomiting, and abdominal cramping. Abdominal radiograph revealed densely radiopaque material in the stomach. Gastrointestinal decontamination was accomplished with activated charcoal and Whole-Bowel Irrigation with polyethylene glycol solution (Golytely) for 24 hours until repeat abdominal radiographs no longer demonstrated the substance in the gastrointestinal tract. He was also chelated with British anti-Lewisite for 5 days, followed by succimer for 10 days. He had markedly elevated urine and blood mercury levels after ingestion, but except for a mildly depressed serum bicarbonate (19 mEq/L), his chemistry results remained normal including blood urea nitrogen and creatinine. He had an uncomplicated hospital course and remained asymptomatic at 6 months postingestion. Despite elevated urine and blood mercury levels after ingestion of HgO, our patient did not develop the end-organ toxicity typical of inorganic mercury poisoning. [Ly BT, Williams SR, Clark RF. Mercuric oxide poisoning treated with Whole-Bowel Irrigation and chelation therapy. Ann Emerg Med. March 2002;39:312-315.]
-
mercuric oxide poisoning treated with Whole Bowel Irrigation and chelation therapy
Annals of Emergency Medicine, 2002Co-Authors: Saralyn R Williams, Richard F ClarkAbstract:Most reported cases of inorganic mercury poisoning are from mercuric chloride. We report a case of mercuric oxide (HgO) powder ingestion. A 31-year-old man presented to an emergency department after ingestion of approximately 40 g of HgO. Soon after ingestion, he developed nausea, vomiting, and abdominal cramping. Abdominal radiograph revealed densely radiopaque material in the stomach. Gastrointestinal decontamination was accomplished with activated charcoal and Whole-Bowel Irrigation with polyethylene glycol solution (Golytely) for 24 hours until repeat abdominal radiographs no longer demonstrated the substance in the gastrointestinal tract. He was also chelated with British anti-Lewisite for 5 days, followed by succimer for 10 days. He had markedly elevated urine and blood mercury levels after ingestion, but except for a mildly depressed serum bicarbonate (19 mEq/L), his chemistry results remained normal including blood urea nitrogen and creatinine. He had an uncomplicated hospital course and remained asymptomatic at 6 months postingestion. Despite elevated urine and blood mercury levels after ingestion of HgO, our patient did not develop the end-organ toxicity typical of inorganic mercury poisoning.
Jonas Höjer - One of the best experts on this subject based on the ideXlab platform.
-
position paper update Whole Bowel Irrigation for gastrointestinal decontamination of overdose patients
Clinical Toxicology, 2015Co-Authors: Ruben Thanacoody, Andrew R Erdman, R. Bédry, Jonas Höjer, Kalle Hoppu, Martin E Caravati, Bill Troutman, Blaine Jess Benson, Bruno MegarbaneAbstract:Context. A position paper on the use of Whole Bowel Irrigation (WBI) was first published in 1997 by the American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centre...
-
position paper update ipecac syrup for gastrointestinal decontamination
Clinical Toxicology, 2013Co-Authors: Jonas Höjer, Andrew R Erdman, B E Benson, Ruben Thanacoody, R. Bédry, William G. Troutman, Bruno Megarbane, Kalle Hoppu, E M CaravatiAbstract:Context. An update of the first position paper on ipecac syrup from 1997 was published by the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists in 2004. The aims of this paper are to briefly summarize the content of the 2004 Position Paper and to present any new data. Methods. A systematic review of the literature from the year 2003 forward. Results. The literature search yielded a limited number of meaningful articles, and there remains no convincing evidence from clinical studies that ipecac improves the outcome of poisoned patients. Furthermore, the availability of ipecac is rapidly diminishing. Conclusions. The routine administration of ipecac at the site of ingestion or in the emergency department should definitely be avoided. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and Whole Bowel Irrigation. There is not sufficient evidence to warrant any change in the previous ipecac posit...
-
successful Whole Bowel Irrigation in self poisoning with potassium capsules
Clinical Toxicology, 2008Co-Authors: Jonas Höjer, Sune ForsbergAbstract:To the Editor:Overdose of slow-release (SR) potassium chloride is uncommon, but life-threatening (1–3). Potassium chloride capsules are radio-opaque (1,4), but effective traditional gastrointestina...
Bruno Megarbane - One of the best experts on this subject based on the ideXlab platform.
-
position paper update Whole Bowel Irrigation for gastrointestinal decontamination of overdose patients
Clinical Toxicology, 2015Co-Authors: Ruben Thanacoody, Andrew R Erdman, R. Bédry, Jonas Höjer, Kalle Hoppu, Martin E Caravati, Bill Troutman, Blaine Jess Benson, Bruno MegarbaneAbstract:Context. A position paper on the use of Whole Bowel Irrigation (WBI) was first published in 1997 by the American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centre...
-
position paper update ipecac syrup for gastrointestinal decontamination
Clinical Toxicology, 2013Co-Authors: Jonas Höjer, Andrew R Erdman, B E Benson, Ruben Thanacoody, R. Bédry, William G. Troutman, Bruno Megarbane, Kalle Hoppu, E M CaravatiAbstract:Context. An update of the first position paper on ipecac syrup from 1997 was published by the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists in 2004. The aims of this paper are to briefly summarize the content of the 2004 Position Paper and to present any new data. Methods. A systematic review of the literature from the year 2003 forward. Results. The literature search yielded a limited number of meaningful articles, and there remains no convincing evidence from clinical studies that ipecac improves the outcome of poisoned patients. Furthermore, the availability of ipecac is rapidly diminishing. Conclusions. The routine administration of ipecac at the site of ingestion or in the emergency department should definitely be avoided. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and Whole Bowel Irrigation. There is not sufficient evidence to warrant any change in the previous ipecac posit...
Ruben Thanacoody - One of the best experts on this subject based on the ideXlab platform.
-
position paper update Whole Bowel Irrigation for gastrointestinal decontamination of overdose patients
Clinical Toxicology, 2015Co-Authors: Ruben Thanacoody, Andrew R Erdman, R. Bédry, Jonas Höjer, Kalle Hoppu, Martin E Caravati, Bill Troutman, Blaine Jess Benson, Bruno MegarbaneAbstract:Context. A position paper on the use of Whole Bowel Irrigation (WBI) was first published in 1997 by the American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centre...
-
position paper update ipecac syrup for gastrointestinal decontamination
Clinical Toxicology, 2013Co-Authors: Jonas Höjer, Andrew R Erdman, B E Benson, Ruben Thanacoody, R. Bédry, William G. Troutman, Bruno Megarbane, Kalle Hoppu, E M CaravatiAbstract:Context. An update of the first position paper on ipecac syrup from 1997 was published by the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists in 2004. The aims of this paper are to briefly summarize the content of the 2004 Position Paper and to present any new data. Methods. A systematic review of the literature from the year 2003 forward. Results. The literature search yielded a limited number of meaningful articles, and there remains no convincing evidence from clinical studies that ipecac improves the outcome of poisoned patients. Furthermore, the availability of ipecac is rapidly diminishing. Conclusions. The routine administration of ipecac at the site of ingestion or in the emergency department should definitely be avoided. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and Whole Bowel Irrigation. There is not sufficient evidence to warrant any change in the previous ipecac posit...
Clinical Toxicologists - One of the best experts on this subject based on the ideXlab platform.
-
position paper ipecac syrup
Clinical Toxicology, 2004Co-Authors: Clinical ToxicologistsAbstract:Syrup of ipecac should not be administered routinely in the management of poisoned patients. In experimental studies the amount of marker removed by ipecac was highly variable and diminished with time. There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the emergency department should be abandoned. There are insufficient data to support or exclude ipecac administration soon after poison ingestion. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and Whole Bowel Irrigation. Ipecac should not be administered to a patient who has a decreased level or impending loss of consciousness or who has ingested a corrosive substance or hydrocarbon with high aspiration potential.A review of the literature since the preparation of the 1997 Ipecac Syrup Position Statement revealed no new evidence that would require a revision of the conclusions of that Statement.
-
position paper Whole Bowel Irrigation
Clinical Toxicology, 2004Co-Authors: Clinical ToxicologistsAbstract:Whole Bowel Irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that WBI improves the outcome of the poisoned patient. Based on volunteer studies, WBI should be considered for potentially toxic ingestions of sustained‐release or enteric‐coated drugs particularly for those patients presenting greater than two hours after drug ingestion. WBI should be considered for patients who have ingested substantial amounts of iron as the morbidity is high and there is a lack of other options for gastrointestinal decontamination. The use of WBI for the removal of ingested packets of illicit drugs is also a potential indication. WBI is contraindicated in patients with Bowel obstruction, perforation, ileus, and in patients with hemodynamic instability or compromised unprotected airways. WBI shou...
