Gastric emptying

Gastric emptying, although logical in theory, is often associated with an insignificant reduction in toxin body burden and a significant potential morbidity ( Table 1).

There is a trend away from gastric emptying and towards the use of effective adsorbents (Lheureux and Askenasi 1991).

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Table 1 Reported complications of gastric lavage

Gastric lavage, where indicated, should be performed with a large-bore evacuation tube designed for this purpose. Lavage through a Salem sump or nasogastric tube is counterproductive. Lavage is contraindicated after the ingestion of caustics and should be employed after ingestion of petroleum solvents only if associated highly toxic products (e.g. organophosphate pesticides) are present. Attention to the airway during gastric emptying maneuvers cannot be overemphasized. Endotracheal intubation, although it is only partially protective, should be performed prior to lavage if there is any question regarding the patient's capacity for self-protection of the airway. Correct positioning of the patient in a left-decubitus Trendelenberg posture is optimal, even in the intubated patient. Lavage with warm water (45 °C) is preferable and should be administered in 4-ml/kg aliquots until the return is clear.

Gastric lavage remains a viable option under the following conditions.

1. Overdose is of massive quantity or of highly toxic potential (e.g. colchicine, chloroquine, cyanide, lithium) and treatment is early (less than 1-2 h).

2. There is a possibility of concretion formation (T.a.b.!e 2.).

Simrs^iieaie (amnios

Table 2 Drugs which may form concretions (bezoars)

3. The ingested toxins are capable of lesion-inducing (as opposed to functional) toxicity ( Table.3).


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Table 3 Examples of toxins inducing specific lesions

4. Adsorbents are ineffective.

Concretions should be considered when toxicity is more persistent than expected and/or plasma concentrations remain elevated relative to the known plasma half-life, and may be identified by plain or contrast radiography (depending on the radio-opacity of the product), ultrasound, or endoscopy. Removal of concretions by endoscopy should be considered in the presence of persistent toxicity. Gastrotomy should be reserved for life-threatening intoxication where a less invasive alternative is not feasible.

Emetics have no place in the treatment of intensive care patients.

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