Gastric Lavage for Poisoning or Overdose
Gastric lavage should not be performed routinely in poisoning or overdose cases, as it lacks proven clinical benefit and carries significant risks including aspiration pneumonia, dysrhythmias, and gastrointestinal perforation. 1, 2
Primary Recommendation
The American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists explicitly recommend against routine use of gastric lavage in poisoned patients. 1, 2, 3 This position is based on:
- Highly variable and time-dependent efficacy: The amount of toxin removed decreases rapidly after ingestion, with minimal benefit beyond 60 minutes 4
- No proven improvement in clinical outcomes: Multiple clinical studies fail to demonstrate that gastric lavage improves length of stay, ICU admissions, or mortality 5, 3
- Significant complication rates: Gastric lavage is associated with higher rates of ICU admissions and aspiration pneumonia compared to activated charcoal alone 5
Absolute Contraindications
Never perform gastric lavage in the following situations: 1, 4, 3
- Corrosive ingestions (strong acids or alkalis) - causes severe tissue damage and perforation 1
- Hydrocarbon ingestions with high aspiration potential 4, 3
- Impaired airway protective reflexes without secured airway (intubation) 1, 4, 3
- Risk of gastrointestinal hemorrhage or perforation 3
Rare Exceptions Where Gastric Lavage May Be Considered
Only consider gastric lavage when ALL of the following criteria are met: 1, 4, 6
- Potentially life-threatening amount of toxin ingested 4
- Presentation within 60 minutes (maximum 1-2 hours) of ingestion 4, 6
- Airway is secured if patient has altered mental status 1
- Substance is not a corrosive or hydrocarbon 1, 4
- Performed only by individuals with proper training and expertise 2
Even when these criteria are met, clinical benefit remains unproven. 2, 3
Preferred Alternative: Activated Charcoal
Activated charcoal is the preferred decontamination method for most poisonings. 1, 7
Administration Guidelines:
- Timing: Administer within 2 hours of ingestion for optimal effectiveness 1, 7
- Dosing: 1-2 g/kg body weight (standard 1 g/kg) 1, 7
- Prerequisites: Intact or secured airway required 7
Substances NOT adsorbed by activated charcoal: 7
- Iron, lithium, alcohols, ethylene glycol
- Alkalis, fluoride, mineral acids, potassium
Special populations: 7
- Children under 1 year: Use only non-sorbitol formulations (sorbitol has caused fatal hypernatremic dehydration) 7
Clinical Decision Algorithm
Step 1: Secure airway and achieve hemodynamic stability first 1, 8
Step 2: Contact poison control center for guidance 7, 8
Step 3: Determine time since ingestion
- If >2 hours: Activated charcoal unlikely to benefit (exception: some drugs like nortriptyline may benefit up to 4 hours) 7
- If <2 hours: Proceed to Step 4
Step 4: Identify substance
- If corrosive, hydrocarbon, or not charcoal-adsorbable: Consider supportive care only 1, 7
- If charcoal-adsorbable: Administer activated charcoal 1, 7
Step 5: Gastric lavage consideration (rarely indicated)
- Only if life-threatening ingestion within 60 minutes AND airway secured AND trained personnel available 2, 4
Common Pitfalls to Avoid
- Do not delay airway protection to perform gastrointestinal decontamination 8
- Do not use gastric lavage routinely - clinical data from 808 patients showed no benefit and increased complications 5
- Do not administer activated charcoal without airway assessment - aspiration risk is significant 7
- Do not use ipecac syrup - explicitly not recommended by American Heart Association and American Red Cross 7
Real-World Clinical Practice
In actual clinical practice, gastric lavage is rarely performed. For example, in ethylene glycol poisoning cases, gastric lavage was used in only 10.5% of patients, and in beta-blocker overdoses requiring extracorporeal treatment, it was used in only 11-75% of cases depending on the agent. 1, 7 This reflects the medical community's recognition that the risks typically outweigh any theoretical benefits.