Toxicology

Decontamination/

Elimination Strategy

Pediatric Dosing

Adult Dosing

Gastric lavagea

10-mL/kg aliquots, followed by return of

an equal amount

200- to 300-mL aliquots, followed by

return of an equal amount

Cathartics

Magnesium citrate:

Sorbitol:

4 mL/kg

4.3 mL/kg (35% solution)

240 mL

1–2 mL/kg (70% solution)

Activated charcoal

Single dose

Multidose

Up to 1 yr of age:

0.5–1 g/kg (usually 10–25 g)

1–12 years:

0.5–1 g/kg (usually 25–50 g)

0.5–1 g/kg (25–50 g), followed by

0.25–0.5 g/kg (10–25 g) every 4 hr

> 12 years and adults:

25–100 g (doses > 50 g may induce

vomiting)b

50 g, followed by 25–50 g every 4 hr

Whole bowel irrigationc

9 mo to 6 yr:

500 mL/hr

6–12 yr:

1000 mL/hr

> 12 yr and adults: Goal is 2000 mL/hr

(initiated at 500 mL/hr and doubled

every 30 min)

Urine alkalinization with

sodium bicarbonated

25–50 mEq intravenously for 1 hr

250 mEq intravenously for 1 hr

aSterile water or 0.9% sodium chloride; may repeat until the return fluid is clear and absent of particulate matter.

bUpper limit may vary depending on the capacity of the stomach.

cPolyethylene glycol electrolyte lavage solutions; dose until the rectal effluent is clear or the desired effect has been achieved.

dSodium bicarbonate in dextrose 5% in water additional boluses can be given hourly (or begin a continuous infusion at this hourly rate) to maintain a urine pH of 7.5–8.5.

Substance

Examples

Acids

Boric acid, mineral acids

Alcohols

Ethanol, ethylene glycol, methanol

Alkalis

Bleach, cleaning solutions, dishwasher detergents, lye

Carbamates

Insecticides, neostigmine, physostigmine

Cyanide

Cyanogen chloride, hydrogen cyanide, potassium cyanide, sodium cyanide

Hydrocarbons

Gasoline, kerosene, petroleum oils

Metals

Arsenic, iron, lead, lithium, mercury

Organic solvents

Acetic acid, acetone, ethylene glycol, glycerin, toluene

Organophosphates

Antihelminthic drugs (trichlorfon), insecticides (malathion, parathion), herbicides