Gastrointestinal decontamination in the acutely poisoned patient

ObjectiveTo define the role of gastrointestinal (GI) decontamination of the poisoned patient.Data sourcesA computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources.Study selection and data extractionClinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient.Data synthesisThe literature suggests that previously, widely used, aggressive approaches including the use of ipecac syrup, gastric lavage, and cathartics are now rarely recommended. Whole bowel irrigation is still often recommended for slow-release drugs, metals, and patients who "pack" or "stuff" foreign bodies filled with drugs of abuse, but with little quality data to support it. Activated charcoal (AC), single or multiple doses, was also a previous mainstay of GI decontamination, but the utility of AC is now recognized to be limited and more time dependent than previously practiced. These recommendations have resulted in several treatment guidelines that are mostly based on retrospective analysis, animal studies or small case series, and rarely based on randomized clinical trials.ConclusionsThe current literature supports limited use of GI decontamination of the poisoned patient

Toward a Comprehensive Approach to the Collection and Analysis of Pica Substances, with Emphasis on Geophagic Materials

Pica, the craving and subsequent consumption of non-food substances such as earth, charcoal, and raw starch, has been an enigma for more than 2000 years. Currently, there are little available data for testing major hypotheses about pica because of methodological limitations and lack of attention to the problem.In this paper we critically review procedures and guidelines for interviews and sample collection that are appropriate for a wide variety of pica substances. In addition, we outline methodologies for the physical, mineralogical, and chemical characterization of these substances, with particular focus on geophagic soils and clays. Many of these methods are standard procedures in anthropological, soil, or nutritional sciences, but have rarely or never been applied to the study of pica.Physical properties of geophagic materials including color, particle size distribution, consistency and dispersion/flocculation (coagulation) should be assessed by appropriate methods. Quantitative mineralogical analyses by X-ray diffraction should be made on bulk material as well as on separated clay fractions, and the various clay minerals should be characterized by a variety of supplementary tests. Concentrations of minerals should be determined using X-ray fluorescence for non-food substances and inductively coupled plasma-atomic emission spectroscopy for food-like substances. pH, salt content, cation exchange capacity, organic carbon content and labile forms of iron oxide should also be determined. Finally, analyses relating to biological interactions are recommended, including determination of the bioavailability of nutrients and other bioactive components from pica substances, as well as their detoxification capacities and parasitological profiles.This is the first review of appropriate methodologies for the study of human pica. The comprehensive and multi-disciplinary approach to the collection and analysis of pica substances detailed here is a necessary preliminary step to understanding the nutritional enigma of non-food consumption

Effects Of Physical And Chemical Modifications On The Disintegrant And Dissolution Properties Of Tacca involucrata Starch

The effects of physical (pregelatinization) and chemical (acid hydrolysis) modifications on the distintegrant and dissolution properties of Tacca involucrate Starch (Tacca starch) were investigated in lactose based tablets containing 0.001% w/w of riboflavin as tracer substance, 10% w/w Tacca starch as disintegrant, 3% w/w acacia as binder, 1% w/w stearic acid as lubricant and enough quantity of lactose as diluent. The starch was incorporated intragranularly, extragranularly and intra/extragranularly. Regardless of the mode of incorporation, Tacca starch was most efficient in effecting the disintegration of the tablets and releasing their riboflavin contents in its unmodified form. In this regard, pregelatinized Tacca starch was more effective as a disintegrant than the acid hydrolysed form of the starch. Generally, fastest disintegration and dissolution were obtained with extragranular incorporation of the three forms of the starch. On the basis of dissolution efficiency values (D>E15), the modifications did not result in any retardation in riboflavin release from the tablets. Key Words: Tacca starch, pregelatinization, acid hydrolysis, extragruanular, intragranular intra/extragranular, dissolution efficiency. Bio-Research Vol.2(1) 2004: 97-10

Evaluation of Some Starches as Disintegrants in Sodium Salicylate Tablet Formulations

The disintegrant properties of official maize and potato starches and locally produced cassava starch in sodium salicylate tablet formulations were studied. The disintegrants were added intragranularly in each batch. Concentration range of 5 % to 15 % w/w of each disintegrant was used. In vitro dissolution profile, uniformity of weight and content, disintegration time, friability and hardness tests were also evaluated. The mean disintegration times obtained at 5 % disintegrant concentrations were 32.33, 33.83, and 41.50 minutes for tablets formulated with maize, cassava and potato starches respectively. At 10 % w/w starch concentration, the mean disintegration times were 28.66, 34.67 and 32.33 minutes for maize, cassava and potato starches respectively, while at 15 % w/w, the results were 33.33, 46.67 and 42.67 minutes for maize, cassava and potato starches respectively. The T50 % obtained for all the batches of tablets produced indicates that all the disintegrants released up to 50 % of the active ingredient within 18 minutes for the range of concentrations investigated. The study showed that the starches tested performed relatively well as disintegrants in the order: maize > potato > cassava, with maize and potato being optimum at 10 % w/w while the locally produced cassava starch was optimum at 5 % w/w in the sodium salicylate tablet formulations.Keywords: disintegrant properties, maize starch, potato starch, cassava starch, sodium salicylate tabletsNigerian Journal of Pharmaceutical Research, Vol. 8 No 1 pp. 203 - 217 (September 2010

PHYSICO-CHEMICAL PROPERTIES OF MANGIFERA INDICA SEED FAT USED AS SUPPOSITORY BASE

The extracted seed fat of Mangifera indica was cream coloured, with a pH of 5.0, and possess pleasant odour. It melted within 32—35oC and remained solid at room temperature. The refractive index is 1.4628. The viscosity is 44.84 poise in the liquid form, and the acid, iodine, saponification and unsaponifiable matter values were found to be 5.046, 43.35, 188 and 1.11g respectively. There was faster and optimal release of salicylic acid from Mangifera indica seed fat when formulated as a suppository then that obtained with cocoa butter. Key Words: Mangifera indica, seed fat, fatty acids, suppositories, salicylic acid Nig. J. Nat. Prod. And Med. Vol.1 1997: 32-3

PROPERTIES OF FILMS OBTAINED FROM THE POLYSACCHARIDE DERIVED FROM DETARIUM MICROCARPIUM GUM

The films obtained from Detarium microcarpium gum were compared in some aspects with gelatin films of equal thickness. Detarium film compared favourably with gelatin as a film former. Unplasticised and plasticised Detarium film absorbed less water than gelatin film, an advantage that could be of immense importance in the formulation of moisture sensitive drug. Key Words: Propeties, films, Detarium microcarpium gum Nig. J. Nat. Prod. And Med. Vol.1 1997: 34-3