What is the role of decontamination in the treatment of tricyclic antidepressant (TCA) toxicity in pediatric patients?

Updated: Mar 18, 2020
  • Author: Derrick Lung, MD, MPH; Chief Editor: Stephen L Thornton, MD  more...
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Answer

Decontamination measures, such as activated charcoal administration and possibly gastric lavage, may have theoretical benefit but the rapid onset of cyclic antidepressant toxicity limits real-life utility. [14]

Activated charcoal

While theoretically beneifical,  activated charcoal should not routinely be used due to the risk of rapid onset of toxicity and aspiration. [15]   It should be administerd only under direct supervision of a medical toxicologist or a poison control center, with assurance of airway control.

Gastric lavage

Gastric lavage should never be used routinely and should only be considered under direct supervision of a medical toxicologists or poison control center.  A 2013 position paper by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists notes that only weak evidence supports gastric lavage as a beneficial treatment, even in special situations. [17]


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