Gastric Lavage

1. Indications
   1. Rarely indicated in 2012
      1. Poor efficacy
      2. Significant nasal trauma from large bore tubes
   2. Historically used in severe ingestion cases
      1. Overdose or Ingestion within 1 hour
      2. Extraordinary overdose with a potentially toxic amount of medication
      3. Specific overdose after 1 hour
         1. Ingested drug slows peristalsis
            1. Anticholinergics
            2. Opioids (Narcotics)
         2. Ingested drug forms Bezoar
            1. Salicylates
            2. Iron
2. Contraindications
   1. Insignificant overdose
   2. Corrosive Ingestion (strong acid or alkali)
   3. Hydrocarbon Ingestion (high aspiration risk)
   4. Minimally effective if given >1 hour post-ingestion
   5. Increased risk of Gastrointestinal Bleeding or perforation
   6. Unprotected airway (e.g. Altered Level of Consciousness)
3. Complications
   1. Aspiration Pneumonia
   2. Laryngeal trauma
   3. Esophageal Perforation
   4. Epistaxis
   5. Electrolyte imbalance
   6. Hypothermia
4. Preparations
   1. Activated Charcoal in aqueous solution (preferred due to lower Emesis, aspiration risk)
   2. Activated Charcoal in Sorbitol
5. Technique
   1. Consider Endotracheal Intubation in advance
      1. Indicated for neurologic Impairment
   2. Use a large bore tube (28 French Ewald tube)
      1. Larger tubes however cause considerable nasal trauma
   3. Position patient
      1. Head down
      2. Left lateral decubitus
   4. Technique
      1. Aspirate first prior to fluid lavage
      2. Instill lavage fluid into Stomach
         1. Adult 100-300 cc warm water or normal saline per wash
         2. Child 10-15 cc/kg warm normal saline per wash
      3. Aspirate fluid back and dispose of fluid
   5. Repeat lavage
      1. Repeat until aspirate clears of pill fragments and similar debris of concern
      2. Single dose is sufficient in many cases
      3. If repeated, alternate aqueous and Sorbitol charcoal preparations every 2 hours
6. References
   1. Vale (2004) J Toxicol Clin Toxicol 42(7): 933-43