Gastric lavage accomplished within 4 to 6 h of ingestion effectively decreases absorption of barbiturates. However, there are no data that gastric lavage is superior to activated charcoal alone. Given the CNS depression associated with this overdose, ipecac should not be used, and induction of emesis should be avoided.
Oral activated charcoal augments drug extraction by adsorbing drugs from the gastrointestinal tract. Multiple-dose activated charcoal (MDAC) is beneficial in reducing serum phenobarbital concentrations; however, no significant difference in clinical outcome has yet been demonstrated. 1 !3 Still, most studies suggest that activated charcoal is at least as effective as lavage and may be better, given its immediate functional effectiveness. Loading dose of activated charcoal is 50 to 100 g, and this may be followed by a single dose of cathartic agent; standard MDAC is 20 to 50 g every 4 h. 14
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