The hazards of gastric lavage for intentional self-poisoning in a resource poor location
Objective. The 10-20% case fatality found with self-poisoning in the developing world differs markedly from the 0.5% found in the West. This may explain in part why the recent movement away from the use of gastric lavage in the West has not been followed in the developing world. After noting probabl...
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Published in | Clinical toxicology (Philadelphia, Pa.) Vol. 45; no. 2; pp. 136 - 143 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Philadelphia, PA
Taylor & Francis
01.01.2007
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Subjects | |
Online Access | Get full text |
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Summary: | Objective. The 10-20% case fatality found with self-poisoning in the developing world differs markedly from the 0.5% found in the West. This may explain in part why the recent movement away from the use of gastric lavage in the West has not been followed in the developing world. After noting probable harm from gastric lavage in Sri Lanka, we performed an observational study to determine how lavage is routinely performed and the frequency of complications. Case series. Fourteen consecutive gastric lavages were observed in four hospitals. Lavage was given to patients unable or unwilling to undergo forced emesis, regardless of whether they gave consent or the time elapsed since ingestion. It was also given to patients who had taken non-lethal ingestions. The airway was rarely protected in patients with reduced consciousness, large volumes of fluid were given for each cycle (200 to more than 1000 ml), and monitoring was not used. Serious complications likely to be due to the lavage were observed, including cardiac arrest and probable aspiration of fluid. Health care workers perceived lavage as being highly effective and often life-saving; there was peer and relative pressure to perform lavage in self-poisoned patients. Conclusions. Gastric lavage as performed for highly toxic poisons in a resource-poor location is hazardous. In the absence of evidence for patient benefit from lavage, (and in agreement with some local guidelines), we believe that lavage should be considered for few patients - in those who have recently taken a potentially fatal dose of a poison, and who either give their verbal consent for the procedure or are sedated and intubated. Ideally, a randomized controlled trial should be performed to determine the balance of risks and benefits of safely performed gastric lavage in this patient population. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Contributions ME designed this study, is the principle investigator of the Ox-Col's poisoning study in Sri Lanka, and wrote the first draft of the paper; ME, SH, KR, KS, and MR carried out the observations; LK visited the hospitals around Anuradhapura and discussed the role of gastric lavage in their clinical practice; AA helped coordinate the visits to the hospitals; MHRS and DAW are senior investigators of the Ox-Col collaboration and supervise its activities; NB is co-investigator of the Ox-Col study and helped design this study. All authors discussed the issues behind the study and revised the first draft; all have approved the final draft. |
ISSN: | 1556-3650 1556-9519 |
DOI: | 10.1080/15563650601006009 |