What is the role of Ryle's tube (RT) insertion in phenyltoin (phenytoin) poisoning?

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Last updated: April 29, 2025 • View editorial policy

From the Guidelines

RT insertion in phenyl poison cases is not recommended as a treatment approach. Phenyl poisoning, typically caused by ingestion or inhalation of phenol-containing products, requires immediate medical attention focused on decontamination, supportive care, and specific antidotal therapy. The standard treatment includes activated charcoal administration (50g orally for adults) if the patient presents within one hour of ingestion, intravenous fluid resuscitation, and monitoring of vital signs. Specific treatments may include N-acetylcysteine (loading dose of 150 mg/kg over 1 hour, followed by maintenance doses) to counteract metabolic toxicity. According to the 2023 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1, the management of poisoning should focus on the treatment of critical poisoning from various substances, including the use of specific antidotes and supportive care, but does not mention radiation therapy as a treatment option for phenyl poisoning. Radiation therapy has no role in managing phenyl poisoning as the pathophysiology involves direct chemical toxicity to tissues and metabolic disruption rather than processes that would respond to radiation. The management should focus on preventing further absorption, enhancing elimination, and providing supportive care for affected organ systems, particularly the liver, kidneys, and central nervous system. Key considerations in the treatment of phenyl poisoning include:

  • Decontamination and supportive care
  • Administration of activated charcoal and N-acetylcysteine as needed
  • Monitoring of vital signs and organ function
  • Use of specific antidotes and treatments as recommended by the American Heart Association guidelines 1
  • Avoidance of unnecessary and potentially harmful treatments, such as radiation therapy.

From the Research

RT Insertion in Phenyl Poisoning

  • RT insertion is not directly mentioned in the provided studies as a treatment for phenyl poisoning.
  • However, the studies discuss various treatment approaches for phenyl poisoning, including: + Decontamination methods such as gastric lavage, activated charcoal, and whole-bowel irrigation 2 + Supportive care, including management of symptoms such as seizures, arrhythmias, and metabolic acidosis 3, 4 + Administration of antidotes, such as methylene blue for methemoglobinemia 3
  • In cases of unknown poisoning, a systematic approach to management is recommended, including initial stabilization, consideration of key history and physical examination findings, and tailored supportive care and decontamination 5
  • The use of activated charcoal is supported by several studies as a means of reducing gastrointestinal absorption of phenol and other substances 3, 6, 2
  • Gastric lavage is generally not recommended due to the risk of serious adverse effects, but may be considered in rare cases where the patient's life is at risk 6, 2

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.