Gastric Lavage in Cases of Poisoning

Common Causes of Poisoning—Etiology, Diagnosis, and Treatment by Dr. med. Dieter Müller, Dipl. Chem. Dr. rer. nat. Herbert Desel in volume 41/2013

Once again a claim is made that gastric lavage is not safe and should be considered only in life-threatening cases and within minutes after the ingestion (1). This “vagueness” demands a closer look at the relevant reference literature.

The cited consensus article (2) updates the data on the basis of animal studies, studies of volunteers, experimental studies in patients, case studies, and clinical studies. Animal studies certainly have nothing in common with the clinical setting. Interestingly, several case reports showed positive outcomes for gastric lavage and endoscopy. With regard to clinical studies: the cited studies are from 1942 to 1966 and did not consider the intoxication dose and the factor of time. Further citations (review of 56 small and heterogeneous, exclusively Chinese, studies) produce a controversial picture. Numerous studies reporting the known possible complications of gastric lavage were mentioned. An unprotected respiratory tract is listed as a contraindication. The role of endoscopy in detoxification (which can be undertaken without protecting the respiratory tract) is not mentioned at all. In spite of all this, six out of 11 poison information centers supported gastric lavage in an international study using the example of acetaminophen (paracetamol) intoxication (3). But enough about the evidence. Recommendations have been copied from one another for years. In cases of life-threatening intoxication, all possible options for detoxification should be considered. Gastric lavage is one such option. In such a situation, a benefit not supported by controlled studies is not a counterargument. The factor of time is no argument either, in substances with an enterohepatic circulation. We have repeatedly encountered situations where the lack of, or delay in, gastric lavage resulted in poor outcomes. Especially from the perspective of continuing medical education, a more careful differentiation of the facts is needed in review articles and in the advice provided by poison information centers.

DOI: 10.3238/arztebl.2014.0100a

Dr. med. Christian Marx

Innere Medizin/Nephrologie, Notfallmedizin, Nordhausen

Dr. med. Manfred Marx

Innere Medizin/Nephrologie, Internistische Intensivmedizin, Nordhausen

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Müller D, Desel H: Common causes of poisoning-etiology, diagnosis and treatment. Dtsch Aerztebl Int 2013; 110: 690–700

2. Benson BE, Hoppu K, Troutman WG, et al.: Position paper update: gastric lavage for gastrointestinal decontamination. Clin Toxicol (Phila) 2013; 51: 140–6

3. Good AM, Kelly CA, Bateman DN: Differences in treatment advice for common poisons by poisons centres—an international comparison. Clin Toxicol (Phila) 2007; 45: 234–9