Gastric lavage

Background

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

Indications

• 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

Contraindications

Absolute

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

Complications

• 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

• Activated Charcoal
• Whole Bowel Irrigation

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