thiamine deficient secondary to eating disorders, chronic disease (e.g., inflammatory bowel disease), or alcoholism The rationale for decontamination (D econtamination) of the poisoned child is discussed in the next section This treatment phase may begin urgently, after or in concert with attention to the ABCDs At times, a decision to perform gastric decontamination through the preferred technique can be made almost immediately upon presentation and, if so, should be instituted as soon as possible, taking into account the patient’s clinical status For example, a toddler with coma, shock, and massive hematochezia who is rushed into the ED by the rescue squad —and for whom there is witnessed or strong circumstantial evidence of massive iron overdose—requires a concerted team effort directed toward resuscitation, stabilization, and urgent gastric decontamination However, an asymptomatic adolescent who ingests 10 g of acetaminophen 30 minutes before arrival at the ED may be fully evaluated in a timely but orderly manner (as outlined in the next section) and considered for less emergent gastric decontamination—in this case, possibly an oral dose of activated charcoal Significant dermal or ocular exposures require immediate copious lavage, and precautions should be taken to protect healthcare providers from exposure At the completion of this initial life support phase, the poisoned patient should have been assessed for compromise of vital airway and cardiorespiratory function and for global neurologic status and should have had resuscitative measures instituted Patients with significant altered mental status have been critically evaluated for respiratory status, have had IV access secured, and have had therapeutic trials of oxygen, glucose, and naloxone Other advanced life support interventions such as anticonvulsants or antiarrhythmics have been instituted as necessary Consideration of decontamination options has begun Evaluation and Detoxification Phase History A brief and focused historical evaluation should be addressed as soon as the life support phase has been completed The primary goal is to determine the potential severity of the exposure, which requires information about both the poison and the patient For a known or highly suspected toxic exposure, attempt to estimate the total amount ingested (number of pills missing, ounces left in the bottle, dosage of pills, concentration of alcohol, and so forth) Also attempt to determine the best estimate of time elapsed since ingestion Ask about early symptoms noted at home or en route to the ED and any treatments administered before arrival