Decontamination

Gastrointestinal decontamination with activated charcoal

For theophylline ingestions between 10 to 30 mg/kg, or caffeine ingestions of 30 to 50 mg/kg, offer gastrointestinal decontamination with activated charcoal to alert and cooperative patients who are able to protect their airway and present within:

2 hours after ingesting an immediate-release preparation
4 hours after ingesting a modified-release preparation.

Antiemetics (eg metoclopramide, ondansetron) are often required to facilitate the administration of activated charcoal. If the patient is intubated, activated charcoal can be given any time after ingestion via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.

For theophylline ingestions of more than 30 mg/kg, or caffeine ingestions of more than 50 mg/kg, give patients activated charcoal as part of the regimen for multiple-dose activated charcoal for enhanced elimination.

Whole bowel irrigation

Following theophylline ingestions of more than 30 mg/kg of a modified-release preparation, consider whole bowel irrigation. Patients must be able to protect their airway or be intubated to undergo whole bowel irrigation. If the patient is intubated, the whole bowel irrigation preparation is given via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.

Discuss the need for whole bowel irrigation and which preparation to use (see Examples of macrogol 3350 (with electrolytes) preparations used for whole bowel irrigation) with a clinical toxicologist. Do not initiate whole bowel irrigation in a patient at significant risk of pulmonary aspiration or with established ileus. During treatment, examine patients hourly for signs of ileus, in particular increasing abdominal distension.