The American Association of Poison Control Centers (AAPCC) estimates that 4 million cases of poisoning occur in humans in the United States each year.1 In 2006, over half (57.2%) of the cases reported to the AAPCC involved children 12 years of age or younger.¹ Most of the toxic exposures occurred by ingestion (77% of cases), and most of these exposures occurred at a residence (92.6%).¹

The approach to the poisoned pediatric patient is complex and involves a number of diagnostic and therapeutic considerations. Just as with the care of any other emergent patient, the initial management of the poisoned pediatric patient should focus on airway patency, ventilatory support, and the maintenance of effective circulation. Consideration should also be given to other therapeutic modalities that are specific to the treatment of the poisoned patient including the prevention of systemic absorption of toxins, enhancing the elimination of absorbed toxins, and the administration of antidotes for specific toxins. This review will focus on gastrointestinal decontamination.

Gastrointestinal decontamination is a term that refers to preventing the absorption of an ingested toxin from the gastrointestinal tract. Available methods for the gastrointestinal decontamination of children include syrup of ipecac, single dose activated charcoal (SDAC), gastric lavage, and whole bowel irrigation. This review will focus on SDAC, gastric lavage, and whole bowel irrigation. Syrup of ipecac is mentioned here for primarily historical reasons, as this therapy is no longer recommended for any poisoned patient by a number of professional medical societies, including the American Academy of Pediatrics (AAP) and the AAPCC.^2,3

The administration of multiple-dose activated charcoal (MDAC) is not considered a mode of gastrointestinal decontamination. It works to enhance the elimination of toxins that have already been absorbed. However, while MDAC is not considered a form of decontamination, activated charcoal is linked to the role of gastrointestinal decontamination. Given this association, this review will discuss activated charcoal’s role when given in multiple dose fashion.

A basic understanding of the remaining methods of gastrointestinal decontamination and the indications and contraindications for the use of each is key to appropriately treating the vast numbers of poisoned children who present to emergency departments each year.

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