Gastric decontamination in the emergency department: What is the consensus?

Abstract

Study objectives: Poison centers have improved care of the acute or chronically poisoned emergency department (ED) patient by allowing rapid access to toxicology experts. In 1997, the American Academy of Clinical Toxicology published a position statement for gastric decontamination. Syrup of ipecac is recommended in the ED, and it was noted that the clinical benefit of gastric lavage has not been confirmed in controlled studies. Additionally, activated charcoal should routinely administered but be considered if a patient has ingested a potentially toxic amount of a poison up to 1 hour previously. Although some minor variation in recommendations would be unusual according to clinical preferences, consistent poison center recommendations are generally expected. We compare recommendations from different poison centers about decontamination of 4 hypothetical patients (A: 3-year-old child ingested 2 Elavil capsules 20 minutes earlier, B: 14-year-old patient with unknown quantity of Tylenol 3 ingested 2 hours earlier who is drowsy and arousable to pain, C: 4-year-old child with 2 Procardia XL ingested 2 hours earlier, and D: 4-year-old child ingested 6 oz albuterol 1 hour ago with pulse rate of 160 beats/min). Methods: Using toll-free access route, 41 of 50 US poison centers were contacted. After informed consent, each was asked their recommendation for ED management in these hypothetical and scripted cases. Results: There were no ipecac and 2 gastric lavage (C, D) recommendations. For case A, 95% (39/41) recommended charcoal, 2 recommended no decontamination ( P P =NS). For case C, 80% (33/41) recommended charcoal and 20% (8/41) no decontamination ( P P =NS). Conclusion: Because there seems to be a fair amount of inconsistency in the use of charcoal in acute ingestion, further studies for or against its use may be helpful.