Ipecac clearly has no role in the emergency department management of digitalis glycoside poisoning. After initial stabilization, administer activated charcoal to prevent further drug absorption.13 The use of gastric lavage is controversial. Because activated charcoal is so effective, lavage has a minimal role, if any. Asystole has been reported in a digoxin-toxic patient presumably from vagal stimulation during lavage. If lavage is contemplated, pretreatment with atropine prior to performing gastric lavage has been suggested. Forced diuresis, hemodialysis, or hemoperfusion have no role in enhancing elimination of digitalis.
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