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In Childhood Poisonings, Clear the Gut Fast

Katherine M. Bennett

Children act fast and so do poisons—be prepared to decide whether an emetic, adsorbent, or cathartic agent is the best choice for ridding a child's gut of a toxic substance.

The evidence behind current practices in the management of poisoning in children was reviewed in the Jan. 20 issue of New England Journal of Medicine. There is substantial indirect evidence, but no rigorous clinical trial, supporting continued use of gastrointestinal (GI) decontamination. According to Michael Shannon, M.D., M.P.H., staff toxicologist for the Massachusetts Poison Control System and author of "Ingestion of Toxic Substances by Children," GI decontamination should not be mandatory treatment because the associated risks may outweigh the benefit. 

When indicated, decontamination should begin as soon as possible. In general, "activated charcoal is the sole intervention needed to treat serious poisonings in children," Shannon wrote. Administration of ipecac syrup in the emergency department lacks substantial value and is not routinely recommended. Given the potential risks associated with cathartic agents, routine use of those substances is not recommended either. Shannon noted that work is under way on identifying the smallest effective dose of activated charcoal in children.