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Delays in gastric emptying and gut hypomotility may result from fasting status, from overdose itself, or from coingestion of opioids or anticholinergic drugs, and controlled release drugs have a prolonged absorption phase [15, 16].Hypoperfusion of the gastrointestinal tract, secondary to hypotension and/or splanchnic vasoconstriction, can slow absorption . Enterohepatic recirculation may play a role in elimination of certain drugs.When drug concentrations are available, the distribution of the drug into tissues may complicate the relationship between concentration and clinical effect.In cases in which drug concentrations are not available but a specific drug is suspected, experts recommend waiting five half-lives prior to clinical determination of brain death .Disclaimer While individual practitioners may differ, this is the position of the College at the time written, after a review of the issue and pertinent literature.
If one is not available, advice can be obtained from a poison control center.
We recommend identification of drugs or toxins by careful history and targeted testing.
An observation period of longer than five half-lives is appropriate when there is a possibility of an extremely large drug overdose, delayed drug absorption, delayed elimination, or interaction with another agent.
In cases where brain death is considered but intoxication is unclear, consultation with a medical toxicologist or clinical toxicologist is recommended to guide decision making regarding the timing or appropriateness of clinical testing, as clinical brain death determination cannot take place until intoxication is excluded.
The American Academy of Neurology (AAN) offers guidance for the diagnosis of brain death.