Is gastric lavage with normal saline (NS) and coconut oil a recommended treatment for any medical condition?

Gastric Lavage with Normal Saline and Coconut Oil

Gastric lavage with normal saline and coconut oil is not a routinely recommended treatment for most medical conditions, with very limited evidence supporting its use only in specific situations such as aluminum phosphide poisoning in resource-limited settings.

Limited Clinical Applications

• Gastric lavage in general is not recommended as a routine intervention for poisoning or overdose management according to position statements from toxicology societies 1, 2.
• Current evidence does not support the routine use of gastric lavage for gastrointestinal decontamination, as it lacks proven clinical benefit and may cause significant complications 1, 3.
• Gastric lavage should only be considered in rare cases of potentially life-threatening poisonings when it can be performed within 60 minutes of ingestion 2, 4.

Specific Use Cases with Limited Evidence

• In resource-limited settings, coconut oil has been mentioned as a potential locally-sourced emollient for wound care in neonates with epidermolysis bullosa, but not specifically for gastric lavage 5.
• A recent systematic review and meta-analysis found very low-quality evidence that gastric lavage with coconut oil might slightly reduce mortality in aluminum phosphide poisoning (RR = 0.82; 95% CI = 0.69 to 0.98) 6.
• Paraffin oil-based gastric lavage showed somewhat stronger evidence for reducing mortality in aluminum phosphide poisoning compared to coconut oil, though still considered low-quality evidence 6.

Contraindications and Risks

• Gastric lavage is contraindicated in patients with:

  • Unprotected airways without endotracheal intubation 2, 4
  • Ingestion of hydrocarbons with high aspiration potential 2
  • Ingestion of corrosive substances 2, 4
  • Loss of airway protective reflexes 2

• Potential complications of gastric lavage include:

  • Nasal trauma and esophageal perforation 4
  • Tracheal intubation and aspiration 4
  • Electrolyte imbalances and hypothermia 4

Alternative Approaches for Gastrointestinal Decontamination

• Activated charcoal (1-2 g/kg orally or via nasogastric tube) is recommended by the American Academy of Pediatrics for certain types of overdoses 7.
• For bowel cleansing, polyethylene glycol (PEG) solutions are preferred over other agents, especially in pediatric patients 8.
• The American Gastroenterological Association advises against sodium phosphate preparations in pediatric patients due to risk of electrolyte abnormalities 8.

Conclusion

• The evidence supporting gastric lavage with normal saline and coconut oil is extremely limited, with only very low-quality evidence for its use in aluminum phosphide poisoning 6.
• For most medical conditions requiring gastrointestinal decontamination or bowel cleansing, other evidence-based approaches should be utilized instead 1, 3, 2.
• If gastric lavage is deemed necessary in rare circumstances, it should only be performed by individuals with proper training and expertise 1.