Emergency Medicine Book

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Cathartic

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  1. Indications (used with Activated Charcoal only)
    1. Gastrointestinal Decontamination
  2. Contraindications
    1. Examination findings
      1. Absent bowel sounds
      2. Recent abdominal surgery or trauma
      3. Bowel perforation
      4. Intestinal Obstruction
      5. Dehydration
      6. Hypotension
    2. Poison ingestion of corrosive substance
    3. Poison ingestion with Diarrheal adverse effects
      1. Organophosphate Poisoning
      2. Carbamate Poisoning
      3. Heavy metal poisoning
    4. Poison ingestion with ileus as adverse effect
      1. Paraquat
      2. Diquat
  3. Precautions
    1. Use only in combination with Activated Charcoal
    2. Avoid Oil Cathartics
      1. Risk of Lipoid Aspiration Pneumonia
      2. Risk outweighs any potential benefit
  4. Protocol: Sorbitol (Single dose)
    1. Adult: 1 to 2 ml/kg of 70% Sorbitol solution
    2. Child: 1.5 to 2.5 ml/kg of 35% Sorbitol solution
  5. Protocol: Alternative
    1. Start with either of:
      1. Sodium Sulfate 250 mg/kg or
      2. Magnesium Sulfate 250 mg/kg
    2. Dilute 1:1 with water
    3. Consider Sorbitol dose prior to Magnesium Sulfate
  6. Complications
    1. Electrolyte imbalance
    2. Dehydration
    3. Hypermagnesemia
  7. Contraindications
    1. Renal Failure
    2. Congestive Heart Failure
    3. Diarrhea
    4. Ileus
    5. Recent bowel surgery
    6. Electrolyte imbalance
    7. Extremes of age

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