Studies on the Efficacy of Gastric Lavage as Practiced in a Large Metropolitan Hospital

Abstract

The efficacy of gastric lavage as it is practiced in a major metropolitan hospital was evaluated. From a population of 76 patients with chemical evidence of sedative-hypnotic drugs in the blood, two or more therapeutic doses were recovered from 15.8% of the lavage samples, and 10 or more therapeutic doses were recovered from 6.6%. In a population consisting of patients with detectable quantities of drugs in the lavage sample, diazepam and amitriptyline are more adequately recovered than the sedative-hypnotic drugs. Very poor recoveries were obtained in patients lavaged more than 2 h after ingestion except in cases of amitriptyline overdose or massive sedative-hypnotic ingestion. The study indicates that inadequate criteria are employed in selecting patients most likely to benefit from lavage. Dose, time since ingestion, and symptomatology are discussed as criteria for selection of patients for lavage.

A comparison of the efficacy of gastric lavage, ipecacuanha and activated charcoal in the emergency management of paracetamol overdose.

“…In early trials looking at the recovery of drugs, usually barbiturates, from gastric washings the amount of drug recovered was low and in a significant proportion of patients no drug was recovered at all (Harstad et al, 1942, Allan, 1961Matthew et al, 1966). Better results have been reported with other drugs with amounts equivalent to 10 therapeutic doses recovered in 50% of patients ingesting salicylate (Matthew et al, 1966) and 33% of patients ingesting amitriptyline (Comstock et al, 1981). When gastric lavage is compared to emesis by measuring the recovery of administered markers it appears that lavage is more effective (Auerbach et al, 1986, Tanberg et al, 1986.…”

Decontamination

“…Gastric lavage is rarely used in acute overdoses of medication, and is typically performed using a 30 French orogastric tube. In experimental animal studies, lavage may decrease absorption by 26% to 37% [48][49][50][51]; however, human studies have not demonstrated a consistent effect on patient outcome [52][53][54]. Due to significant evidence of morbidity including aspiration, laryngospasm, and esophageal perforation [55], lavage should not be used unless the GI toxin is life threatening and the procedure can be completed within 1 hour of ingestion [55].…”

Abandon gastric lavage in the accident and emergency department?

“…More recent experience with barbiturates merely serves to confirm that gastric lavage only retrieves large amounts in a minority of those treated. Comstock et al (1981) recovered more than two therapeutic doses in 13-9% of poisonings with short-acting barbiturates and 22-7% with phenobarbitone. However, only five patients surrendered between 11 and 20 therapeutic doses.…”

“…Matthew et al (1966) considered more than 200 mg of a barbiturate was enough while Comstock et al (1981) regarded two therapeutic doses as success. But by any standard these are small amounts and whether their recovery in borderline cases would weight the scales in favour of survival or reduced morbidity by the time patients reach hospital must be open to serious doubt.…”