Gastrointestinal decontamination and systemic drug removal

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1. Activated charcoal premixed with sorbitol, 50 gm PO or via nasogastric tube q4h around-the-clock until theophylline level is less than 20 mcg/mL. Maintain head-of-bed at 30 degrees to prevent charcoal aspiration.

2. Hemodialysis is as effective as repeated oral doses of activated charcoal and should be used when charcoal hemoperfusion is not feasible.

3. Indications for charcoal hemoperfusion: Coma, seizures, hemodynamic instability, theophylline level >60 mcg/mL; rebound in serum levels may occur after discontinuation of hemoperfusion.

4. Seizures are generally refractory to anticonvulsants. High doses of lorazepam, diazepam or phenobarbital should be used; phenytoin is less effective.

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