Position Paper: Cathartics

  title={Position Paper: Cathartics},
  author={Clinical Toxicologists},
  journal={Journal of Toxicology: Clinical Toxicology},
  pages={243 - 253}
The administration of a cathartic alone has no role in the management of the poisoned patient and is not recommended as a method of gut decontamination. Experimental data are conflicting regarding the use of cathartics in combination with activated charcoal. No clinical studies have been published to investigate the ability of a cathartic, with or without activated charcoal, to reduce the bioavailability of drugs or to improve the outcome of poisoned patients. Based on available data, the… 
Gastrointestinal Decontamination of the Poisoned Patient
This article challenges the accepted precepts of gut decontamination and assesses the utility of syrup of ipecac-induced emesis, orogastric lavage, single-dose-activated charcoal, cathartics, and whole-bowel irrigation.
The revised position papers on gastric decontamination.
The AACT/EAPCCT Position Statements published between 1997 and 19991–5 concluded that there was insufficient clinical trial evidence to support the use of any form of gastrointestinal decontamination in any situation, and future trials will need to pay closer attention to ensuring random allocation, allocation concealment, and avoidance of selection or outcome bias.
Bowel perforation after single-dose activated charcoal.
A patient with pre-existing undiagnosed diverticular disease who developed sigmoid perforation after a single dose of activated charcoal, given without cathartic for a drug overdose is described.
An exploratory study; the therapeutic effects of premixed activated charcoal–sorbitol administration in patients poisoned with organophosphate pesticide
It was demonstrated that the administration of AC–sorbitol was not associated with outcome measures for effectiveness and did not significantly increase either aspiration pneumonia or electrolyte imbalances during hospitalization and further qualified trials with a sufficient number of patients are needed.
Fundaments of Toxicology-Approach to the Poisoned Patient.
Hemodialysis is the most inexpensive, widely available, and most commonly used method of extracorporeal drug removal in the treatment of poisoning.
Ingestions of benzydamine-containing vaginal preparations
This is the largest report of benzydamine ingestions and the outstanding feature was the high percentage of neurological manifestations in children and adults, mainly hallucinations, following the ingestion of an over-the-counter product.
Investigation and management of the poisoned patient.
The diagnosis of acute poisoning may be clear, but it should also be considered in patients who present with altered consciousness, those unable to give a history and those who present with an
Toxicology in the ICU: Part 1: general overview and approach to treatment.
General management, laboratory tests, enhanced elimination, and emerging therapies are discussed; the management of specific overdoses is addressed, which will cover plants, mushrooms, envenomations, and heavy metals.


Saline cathartics and saline cathartics plus activated charcoal as antidotal treatments.
The results of this experimental study indicate that Na2SO4 reduces the gastrointestinal absorption of aspirin, but not that of pentobarbital, chlorpheniramine, or chloroquine; and saline cathartics should not be used in lieu of AC for treatment of poison ingestions.
Hypermagnesemia. A potential complication during treatment of theophylline intoxication with oral activated charcoal and magnesium-containing cathartics.
It is suggested that sorbitol be considered the cathartic agent of choice in the treatment of theophylline toxicity with OAC and magnesium citrate.
A comparison of cathartics in pediatric ingestions.
Sorbitol, when administered with activated charcoal in the treatment of children with acute ingestions, produced a shorter time to first stool and more stools than magnesium citrate, magnesium sulfate, or water.
Gastrointestinal transit times of a charcoal/sorbitol slurry in overdose patients.
Though a prospective, controlled study needs to be performed, variation in dosage of the CSS may be appropriate in select patient groups to offset the effects of the ingestant on bowel motility.
Effect of Saline Cathartics on Gastrointestinal Transit Time of Activated Charcoal
The effects of saline cathartics on the gastrointestinal transit time of activated charcoal were investigated in six healthy volunteers and some volunteers complained of slight abdominal discomfort in all the phases except the Andrew's Liver Salt phase.
Influence of prokinetics on the gastrointestinal transit and residence times of activated charcoal.
Cathartic efficiency is enhanced by alteration of gastrointestinal motility with propantheline, which reduces the transit and residence times of activated charcoal.
Effects of Magnesium Citrate and Clidinium Bromide on the Excretion of Activated Charcoal in Normal Subjects
The results support previous studies of the effects of cathartics on the excretion of activated charcoal, and suggest that cathartic efficacy is not inhibited by anticholinergic drugs when used in therapeutic doses.
Contribution of sorbitol combined with activated charcoal in prevention of salicylate absorption.