Can gastric lavage be substituted by voluntarily drinking a lot of water, especially in pregnant women?

From the Guidelines

Gastric lavage cannot be substituted by voluntarily drinking a lot of water, especially in pregnant women. This approach is not only ineffective for removing toxins but also poses significant risks, including water intoxication (hyponatremia), vomiting, aspiration, electrolyte imbalances, or fluid overload, which can be particularly dangerous for both the mother and the fetus 1. The procedure of gastric lavage is a controlled medical intervention that requires proper technique, positioning, and airway protection, which cannot be replicated by self-administered water intake. In the context of pregnant women, the use of tap water enemas for colon preparation during sigmoidoscopy has been recommended by the US Multi-Society Task Force on Colorectal Cancer, highlighting the importance of medically supervised procedures for any form of intestinal or gastric intervention 1. Key considerations include:

• The risks associated with excessive water intake, such as hyponatremia
• The ineffectiveness of water in removing toxic substances from the stomach
• The potential for vomiting and aspiration
• The importance of seeking immediate medical attention in cases of suspected poisoning. Given these points, attempting to substitute gastric lavage with voluntary water intake is not advisable and could lead to serious health complications.

From the Research

Gastric Lavage and Water Intake

• Gastric lavage is a procedure where the stomach is flushed with a liquid to remove its contents, often used in cases of poisoning.
• The question of whether gastric lavage can be substituted by voluntarily drinking a lot of water, especially in pregnant women, is complex and requires examination of existing research.

Existing Research on Gastric Lavage

• Studies such as 2 and 3 suggest that gastric lavage should not be employed routinely in the management of poisoned patients, as its effectiveness is variable and it may cause significant morbidity.
• Research by 4 indicates that there is no evidence to support the claim that gastric lavage pushes poisons beyond the pylorus into the small bowel, which is a commonly cited complication.
• A study by 5 compared the use of 0.9% normal saline solution and tap water for gastric lavage, finding no significant difference in their effectiveness.

Water Intake and Gastric Lavage

• There is no direct evidence to suggest that voluntarily drinking a lot of water can substitute for gastric lavage in cases of poisoning.
• However, drinking water may help to dilute the toxin in the stomach, but this is not a recommended substitute for medical treatment in cases of poisoning.
• It is essential to note that gastric lavage, when performed, should be done by medical professionals in a controlled environment, as it can have complications, especially if not performed correctly.

Considerations for Pregnant Women

• The safety and efficacy of gastric lavage in pregnant women are not well-studied, and any medical intervention should be approached with caution.
• Pregnant women who have ingested a potentially toxic substance should seek medical attention immediately, where the appropriate course of treatment can be determined by healthcare professionals.
• There is no research to suggest that voluntarily drinking a lot of water is a safe or effective substitute for gastric lavage or other medical treatments in pregnant women who have ingested toxins.