UMEM Educational Pearls

Title: Noncontrast CT to Detect Pills in OD

Keywords: CT, Overdose, Pills (PubMed Search)

Posted: 2/21/2019 by Kathy Prybys, DO
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The primary tenet of poisoning treatment is to separate the patient from the poison. Gastric decontamination has been the cornerstone of poisoning treatment throughout history and methods include induced emesis, nasogastric suctioning, EGD or gastrostomy retrieval, activated charcoal, and whole bowel irrigation. Current guidelines for gastic decontamination are limited to few clinical situations. The detection of residual life threatening poisons in the stomach would be of value in predicting who might benefit from gastric decontamination in overdose.

Plain radiographs have variable sensitvity in detecting radioopaque pills. Computed tomography (CT) has been successful and gained wide acceptance in the detection of drug in body packers. In a recent study, authors studied the usefulness of non-contrast abdominal computed tomography for detection of residual drugs in the stomach in patients presenting over 60 minutes from acute drug overdose:

140 patients were included in this study
Median ingested drug amounts were 28 tablets or capsules
Median time until CT scan was performed after drug ingestion was 4 hours
Multiple types of drugs were ingested in 53.6%
Sustained-release drugs were ingested in 17.1 %
Gastric lavage and WBI were performed on 32.9% patients
Drugs were detected in 25.7% in the non-contrast CT scan performed over 60 min after ingestion.
Total duration of hospital stay was significantly longer in the “presence of drugs” group

BOTTOM LINE:

Non-contrast CT may help to predict which patients would benefit from gastric decontamination in acute life-threatening drug poisonings.

References

Position paper update: gastric lavage for gastrointestinal decontamination. Benson B, Hoppu K, et al. Clin Toxicol. 2013;51:140–146.

American Academy of Clinical Toxicology & European Association of Poisons Centres and Clinical Toxicologists (2005) Position Paper: Single-Dose Activated Charcoal, Clinical Toxicology, 43:2, 61-87.

Are ingested lithium sulphate tablets visible on x-ray? A one-year prospective clinical survey. Höjer J, Svanhagen AC. 2012. Clinical Toxicology, 50:9, 864-865.

The usefulness of non-contrast abdominal computed tomography for detection of residual drugs in the stomach of patients with acute drug overdose, Yong Sung C, Seung-Whan C, et al. 2019. Clinical Toxicology.