Decontamination

Recently ingested arsenic compounds may be visible on abdominal X-ray. If radio-opaque matter is visible on X-ray, 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.

Gastrointestinal decontamination with activated charcoal has no role in the treatment of acute arsenic poisoning because activated charcoal does not bind arsenic.