Gastric lavage

Background

1. Of limited/infrequent utility
2. Almost never used in conscious and cooperative patients should be minimal (< 5% of presentations)
3. restricted to poisonings where benefits over oral Activated Charcoal are likely

Indications

1. Life-threatening poisoning (or history is not available) and unconscious presentation
2. Life-threatening poisoning and presentation within 1 hour
3. Life-threatening poisoning with drug with anticholinergic effects and presentation within 4 hours
4. Ingestions of sustained release preparation of significantly toxic drug
5. Large salicylate poisonings presenting within 12 hours
6. Iron or lithium poisoning

Contraindications

Absolute

1. Corrosive ingestions or oesophageal disease

Technique

1. Protect airway (endotracheal intubation) if patient is stuporous or comatose
2. Lie patient on their left side
3. Insert a large bore double lumen orogastric tube
4. Aspirate stomach contents
5. Use a small cycle lavage of 50-100 mL (and then aspirate)
6. Lavage is rarely indicated beyond 5 minutes, unless tablets are still actively being returned

It is no longer recommended to have a completely clear return before ceasing gastric lavage.

Complications

1. Increase gastric delivery of tablets into the small bowel
2. Aspiration of gastric contents (3% of patients)
3. Esophageal Rupture (rare)
4. Profound bradycardia, cardiac arrest, and asystole may be precipitated by lavage in poisonings with propranolol, calcium channel blockers and other drugs affecting cardiac conduction
   1. Atropine should be used to block the increased vagal tone associated with the procedure in these situations

See Also

Activated Charcoal

Source

Vale JA. Position statement: gastric lavage. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 1997;35(7):711-9