A Comparison of the Efficacy of Emetic Drugs and Stomach Lavage

Abstract

ACCORDING TO Arena,1 and Krimmel and Sunshine,2 more than 500,000 cases of poisoning occur each year in this country, with about 1,500 resultant deaths. Arena1 states that the number of child deaths from accidental poisoning exceeds the total number of deaths caused by measles, polio, scarlet fever, and diphtheria. In many types of poisoning the primary step in treatment is to evacuate the stomach.Berry and Lambdin3 point out that one of two methods is generally employed for emptying the stomach of toxic material; stomach lavage or pharmacologically-induced emesis. There are differences of opinion as to which is the best method: Robertson4 suggested the use of syrup of ipecac, Berry and Lambdin3 prefer apomorphine hydrochloride (HCl), while Arnold et al5 found that stomach lavage is less effective than syrup of ipecac.Since there seems to be no general agreement as to which is the best emetic, nor indeed as to whether emesis or gastric lavage is the better method for emptying the stom¬ ach, we believed it would be worthwhile to investigate quantitatively in animals the stomach-emptying effect of these agents as measured by percentage recovery of a test meal of barium sulfate. We decided to thus compare the effects of the emetic drugs, syr¬ up of ipecac, apomorphine HCl and lobeline sulfate (SO4) and those of gastric la¬ vage.We decided first to determine the minimal dose of apomorphine HCl, syrup of ipecac, and lobeline S04 which would induce emesis in 100% of our animals; and then to estab¬ lish an "optimal emetic dose" of each drug (based on ability to recover barium sulfate).We then determined the effect of the time interval between ingestion and treatment on the percentage of barium sulfate recovered by the optimal emetic dose of the above mentioned drugs, or stomach lavage. Methods and MaterialsColorimetrie Assay of Barium Sulfate.-The method which was employed in this analysis was a modified combination of the method of the United States Pharmacopeia,® and that of Frediani and Bablee.7 The method was as fol¬ lows: 15 gm of the vomitus was mixed with 4 gm of anhydrous potassium carbonate and the mixture heated in a crucible at 750 C until fu¬ sion was completed. The residue was washed with distilled water, dissolved in acetic acid and the barium was assayed as described by Fredi¬ ani and Bablee.Determination of the Optimal Emetic Doses.-First we determined the lowest dose of apo¬ morphine HCl that caused 100% emetic re¬ sponse in the young dog. This dose was found to be 0.15 mg/kg, subcutaneously (SC). The 100% emetic dose being determined, we pro-

Clinical Pharmacokinetics of Oral Activated Charcoal in Acute Intoxications

“…the stomach (Abdallah and Tye, 1967;Arnold et aI., 1959;Boxer et aI., 1969;Corby et aI., 1967). Apomorphine and ipecac are of approximately equal value in children (Corby et aI., 1968).…”

Treatment of the Poisoned Child

“…In contrast, when ipecac was given within the same time interval 39% of the ingested poison was recovered. Abdallah and Tye (1967) compared the effects in young dogs of syrup of ipecac, apomorphine hydrochloride, and lobeline sulphate with gastric lavage by measuring the percentage recovery of a test meal of barium sulphate. At 60 minutes time lapse after administration of the test meal all drugs were significantly superior to lavage in emptying the stomach.…”

Toxicology in the Emergency Department

“…One study noted that 1 hr postingestion, only a 12% decrease in the poison absorption was noted with the use of gastric lavage. Animal studies have demonstrated only an 8%-13% removal of stomach contents when lavage was performed 60 min postingestion (Abdallah & Tye, 1967;Arnold, Hodges, & Barta, 1959).…”