Gastric lavage

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  • Of limited/infrequent utility
  • Almost never used in conscious and cooperative patients
  • Restricted to poisonings where benefits over oral Activated Charcoal are likely


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



  • Corrosive ingestions or esophageal disease


  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 5min, unless tablets are still actively being returned
  7. It is no longer recommended to have a completely clear return before ceasing lavage


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

See Also


  • 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