Decontamination and Enhanced Elimination

Gastric decontamination should be initiated in all patients with suspected NSAID overdoses. Activated charcoal with the cathartic sorbitol should be given orally or through a nasogastric tube. Repeated doses of activated charcoal without sorbitol are indicated in symptomatic patients. Dialysis and charcoal hemoperfusion are not effective in enhancing elimination, because NSAIDs are highly protein bound. Manipulation of serum and urine pH through alkalinization is not helpful in enhancing elimination.

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