Medication Summary
Pharmacologic treatment is rarely indicated. Gastrointestinal decontamination may be appropriate if the patient presents very soon after ingestion. Anticonvulsant therapy is indicated for seizures.
GI decontaminant
Class Summary
Empirically used to adsorb toxin in GI tract. A cathartic is used to enhance movement of toxin through the GI tract. However, no evidence indicates that cathartics increase the efficacy of activated charcoal.
Activated charcoal (Liqui-Char)
Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water.
For maximum effect, administer within 30 min after ingesting poison.
Benzodiazepines
Class Summary
Depresses all levels of CNS (eg, limbic formation, reticular formation), possibly by increasing activity of GABA.
Midazolam (Versed)
Used as alternative in termination of refractory status epilepticus. Because water soluble, it takes approximately 3 times longer than diazepam to peak EEG effects. Thus, clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose. Has twice the affinity for benzodiazepine receptors than diazepam. May be administered IM if unable to obtain vascular access.
Diazepam (Valium)
First-line therapy for seizure control. Can be given by ET/PR (not FDA approved) in an emergency.
Lorazepam (Ativan)
Sedative hypnotic with short onset of effects and relatively long half-life.
By increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation.
Monitoring patient's blood pressure after administering dose is important. Adjust prn. Alternative to diazepam. Can be given IM/ET (not FDA approved) in emergency.
