Toxicology
A positive test also does not necessarily confirm the diagnosis because another agent may be present
but at concentrations below a detectable threshold. In addition, a positive test does not indicate that
the patient is intoxicated on the particular substance (e.g., cocaine is positive for 3 days; however,
its effects last only a few hours) or that the agent ingested is the exact agent that is screened (e.g.,
Patient Case
A 53-year-old man (height 74 inches, weight 97 kg [215 lb]) arrives in the ED confused and disoriented. He
cannot provide any information about his condition or medical history. Vital signs are as follows: BP 85/50
mm Hg, HR 120 beats/minute, RR 28 breaths/minute, and temperature 99.2°F (37.3°C). On physical exami-
nation, an unmarked pill bottle is found in his pocket. Two tablets remain, and a possible drug overdose is
suspected. Which is most appropriate to do first for this patient?
No particular strategy is preferred to another; each has certain advantages and disadvantages, and the risks
and benefits must be considered before use. Consensus statements from the American Academy of Clinical
Toxicology and the European Association of Poisons Centres and Clinical Toxicologists recommend against
the routine use of any decontamination strategy but suggest that these strategies play a role in individualized
care after a poison exposure (Clin Toxicol 2013;51:127). Table 2 lists the common dosing strategies for
general decontamination and enhanced elimination.
Ipecac is no longer manufactured in the United States since 2010 and is no longer recommended because
of concerns for safety and ability to improve outcomes for patients who have been poisoned.
the chemoreceptor trigger zone in the medulla.
Guidelines recommend ipecac (if available) to be given only under a specific recommendation from
a poison control center, ED physician, or other qualified medical personnel when all the following
conditions are met (Clin Toxicol 2013;51:134-9; Clin Toxicol 2005;43:1-10):
No specific contraindication exists for use.
There is a substantial risk of serious toxicity of the toxin to the patient.
No alternatives are available or considered effective to reduce the toxin absorption.
| d. | A delay of more than 1 hour is expected before arrival to a medical facility. |
|---|
Use of ipecac will not adversely affect a more definitive treatment option.