Acute pediatric lead poisoning: Combined whole bowel irrigation, succimer therapy, and endoscopic removal of ingested lead pellets

Clifton, Jack C.; Sigg, Todd; Burda, Anthony M.; Leikin, Jerrold B.; Smith, Christopher J.; Sandler, Richard H.

doi:10.1097/00006565-200206000-00013

Cited by 15 publications

(11 citation statements)

References 30 publications

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“…A gastroenterologist or surgeon may need to be contacted for removal of a larger lead-containing object out of the GI tract if it is likely that the object will not move adequately with GI peristalsis [173]. Likewise patients with evidence of lead poisoning may require surgical removal of lead containing bullet fragments lodged in soft tissues and/or joint spaces [134].…”

Section: Treatmentmentioning

confidence: 99%

Heavy metal poisoning: management of intoxication and antidotes

Rusyniak

Arroyo

Acciani

et al. 2010

Experientia Supplementum

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Abstract. Of the known elements, nearly 80% are either metals or metalloids. The highly reactive nature of most metals result in their forming complexes with other compounds such oxygen, sulfide and chloride. Although this reactivity is the primary means by which they are toxic, many metals, in trace amounts, are vital to normal physiological processes; examples include iron in oxygen transport, manganese and selenium in antioxidant defense and zinc in metabolism. With these essential metals toxicity occurs when concentrations are either too low or too high. For some metals there are no physiological concentrations that are beneficial; as such these metals only have the potential to cause toxicity. This chapter focuses on four of these: arsenic, mercury, lead and thallium.

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Section: Treatmentmentioning

confidence: 99%

Heavy metal poisoning: management of intoxication and antidotes

Rusyniak

Arroyo

Acciani

et al. 2010

Experientia Supplementum

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“…Clifton et al (33) reported the case of a 21-monthold girl who was examined in an ED 12 hours after ingestion of an unknown amount of lead BB pellets. The past medical history was significant for a routine blood lead level of 12 mg/dL.…”

Section: Zinc Sulfatementioning

confidence: 99%

Position Paper: Whole Bowel Irrigation

Toxicologists¹

2004

Journal of Toxicology: Clinical Toxicology

119

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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 should be used cautiously in debilitated patients or in patients with medical conditions that may be further compromised by its use. The concurrent administration of activated charcoal and WBI may decrease the effectiveness of the charcoal. The clinical relevance of this interaction is uncertain. A review of the literature since the preparation of the 1997 Whole Bowel Irrigation Position Statement revealed no new evidence that would require a revision of the conclusions of the Statement.

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“…Support for endoscopic therapy consists of limited case reports of retrieval in ingestions of cocaine packets, lead pellets, and medication such as sustained release calcium channel antagonists, clomipramine, iron, and meprobamate [102][103][104][105][106]. The procedure might be warranted for certain ingestions or cases of pharmacobezoar formation of toxic substances.…”

Section: Endoscopy and Surgerymentioning

confidence: 99%

Drugs and pharmaceuticals: management of intoxication and antidotes

Smith

2010

Experientia Supplementum

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The treatment of patients poisoned with drugs and pharmaceuticals can be quite challenging. Diverse exposure circumstances, varied clinical presentations, unique patientspecific factors, and inconsistent diagnostic and therapeutic infrastructure support, coupled with relatively few definitive antidotes, may complicate evaluation and management. The historical approach to poisoned patients (patient arousal, toxin elimination, and toxin identification) has given way to rigorous attention to the fundamental aspects of basic life supportairway management, oxygenation and ventilation, circulatory competence, thermoregulation, and substrate availability. Selected patients may benefit from methods to alter toxin pharmacokinetics to minimize systemic, target organ, or tissue compartment exposure (either by decreasing absorption or increasing elimination). These may include syrup of ipecac, orogastric lavage, activated single-or multi-dose charcoal, whole bowel irrigation, endoscopy and surgery, urinary alkalinization, saline diuresis, or extracorporeal methods (hemodialysis, charcoal hemoperfusion, continuous venovenous hemofiltration, and exchange transfusion). Pharmaceutical adjuncts and antidotes may be useful in toxicant-induced hyperthermias. In the context of analgesic, anti-inflammatory, anticholinergic, anticonvulsant, antihyperglycemic, antimicrobial, antineoplastic, cardiovascular, opioid, or sedative-hypnotic agents overdose, N-acetylcysteine, physostigmine, L-carnitine, dextrose, octreotide, pyridoxine, dexrazoxane, leucovorin, glucarpidase, atropine, calcium, digoxin-specific antibody fragments, glucagon, high-dose insulin euglycemia therapy, lipid emulsion, magnesium, sodium bicarbonate, naloxone, and flumazenil are specifically reviewed. In summary, patients generally benefit from aggressive support of vital functions, careful history and physical examination, specific laboratory analyses, a thoughtful consideration of the risks and benefits of decontamination and enhanced elimination, and the use of specific antidotes where warranted. Data supporting antidotes effectiveness vary considerably. Clinicians are encouraged to utilize consultation with regional poison centers or those with toxicology training to assist with diagnosis, management, and administration of antidotes, particularly in unfamiliar cases.

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Acute pediatric lead poisoning: Combined whole bowel irrigation, succimer therapy, and endoscopic removal of ingested lead pellets

Cited by 15 publications

References 30 publications

Heavy metal poisoning: management of intoxication and antidotes

Heavy metal poisoning: management of intoxication and antidotes

Position Paper: Whole Bowel Irrigation

Drugs and pharmaceuticals: management of intoxication and antidotes

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