Gastric Lavage Contraindications in Poisoning
Gastric lavage is absolutely contraindicated in corrosive substance ingestion (acids or alkalis) and hydrocarbon ingestion with high aspiration potential, as these can cause severe tissue damage, perforation, and aspiration pneumonia. 1
Absolute Contraindications to Gastric Lavage
Corrosive Substance Ingestion
- Strong acids and alkalis cause immediate liquefactive or coagulative necrosis of tissues, and gastric lavage risks esophageal or gastric perforation. 1, 2, 3
- Corrosive ingestions include strong acids (hydrochloric acid, sulfuric acid, phosphoric acid) and alkalis (sodium hydroxide, potassium hydroxide, ammonia). 4, 5
- The blind passage of a nasogastric tube is contraindicated because damaged pharyngeal and esophageal tissues are at high risk of iatrogenic perforation. 6
- Induced emesis is strictly contraindicated in acid ingestion due to risk of re-exposure of the esophagus to the corrosive agent. 3
- Neutralization attempts and gastric lavage are contraindicated in corrosive ingestions according to established treatment protocols. 2
Hydrocarbon Ingestion with High Aspiration Potential
- Gastric lavage is contraindicated when hydrocarbons with high aspiration potential have been ingested due to severe risk of chemical pneumonitis. 1
Loss of Airway Protective Reflexes
- Unless the patient is intubated with a cuffed endotracheal tube, gastric lavage is contraindicated if airway protective reflexes are lost, due to high aspiration risk. 1
Clinical Context for Gastric Lavage Use
When Gastric Lavage May Be Considered (If Not Contraindicated)
- Gastric lavage should not be employed routinely in poisoned patients, as there is no certain evidence that its use improves clinical outcome. 1
- It should only be considered if a patient has ingested a potentially life-threatening amount of poison AND the procedure can be undertaken within 60 minutes of ingestion. 1
- Even within this narrow timeframe, clinical benefit has not been confirmed in controlled studies. 1
- In experimental studies, the amount of marker removed by gastric lavage was highly variable and diminished significantly with time after ingestion. 1
Management of Corrosive Ingestions (Without Lavage)
Immediate Management
- Dilution with water or milk may be performed within 60 minutes of ingestion to reduce local tissue damage. 2
- Stabilize all vital parameters including airway, breathing, and circulation before proceeding with further interventions. 2
- Withhold all oral feedings immediately. 2
Diagnostic Approach
- Oesophagoscopy within 12-24 hours is the best diagnostic procedure to determine presence and severity of corrosive esophageal lesions, but should be stopped at the first sign of injury to prevent iatrogenic perforation. 2, 6
- Computed tomography is recommended for emergency evaluation of caustic ingestion to assess for transmural necrosis and perforation. 4