Abstract
Objective: Gastric lavage is mandatory irrespective of nature in all patients with acute poisoning in India. Present study was undertaken with aim whether lavage done using nasogastric Ryle’s tube and small aliquots of water or normal saline is safe. Patients and Methods: All the patients above 12 years of age admitted consecutively with pesticide ingestion or exposure between July 2004 to June 2005 were studied with respect to complications associated with lavage using Ryle’s tube. Forty five patients were admitted directly to our hospital and lavage was undertaken using Ryle’s tube (16F ) with 100 - 200 mL of aliquots till 1 - 1.5 liters of fluid was lavaged, with prophylactic endotracheal intubation in patients with Glasgow coma scale ( GCS) < 10 (group I). The incidence of complications related to lavage in group I was compared to that in 53 patients admitted during same period with pesticide poisoning but lavaged outside using nasogastric Ryle’s tube and referred to our institute (group II). Results: The significant complications observed in group I were significant drop in SaO2 (6 patients) laryngospasm, tachycardia, electrolyte imbalance and tube getting struck in throat (one each). In one patient in group I (had no prophylactic intubation though GCS 3) In group II, 7 had aspiration pneumonia (no prophylactic intubation). Other significant complication was drop in SaO2 during lavage. None of them had any serious life threatening complication. Conclusion: Gastric lavage carried out using nasogastric Ryle’s tube and small aliquots of water or normal saline is relatively safe in patients with pesticide poisoning when combined with prophylactic endotracheal intubation in patients with GCS < 10. In absence of prophylactic intubation, risk of aspiration is there. However aspiration pneumonia is generally mild and not life threatening.
Highlights
Gastric lavage has to be carried out by treating physician in all patients with acute poisoning in India irrespective of nature, severity of poisoning and time interval between ingestion and arrival to hospital as lavage sample has to be provided to legal authorities in addition to blood, urine and other samples
Gastric lavage has to be carried out in all patients with acute poisoning in India by treating physician irrespective of whether suicidal or accidental as lavage sample has to be provided to legal authorities [1,2]
This is unlike West where suicide is not considered a criminal offence and it is not necessary to collect gastric lavage sample
Summary
Gastric lavage has to be carried out by treating physician in all patients with acute poisoning in India irrespective of nature, severity of poisoning and time interval between ingestion and arrival to hospital as lavage sample has to be provided to legal authorities in addition to blood, urine and other samples. As per Indian law, attempt to commit suicide is an offence under section 309 of I.P.C which states that whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for a term which may extend to one year or with fine or with both [2] This is in contrast to developed countries where suicide is not a criminal offence and lavage is rarely carried out as there is no evidence that it is effective at all [3,4,5,6,7] and can lead to significant morbidity and mortality [3,8]. In developed countries unlike developing countries, drug overdoses are commonest form of poisoning [4] These carry a low case fatality ratio due to availability of effective antidotes and patients being managed in well equipped hospitals [4,5,6,7]. The study was not designed to determine whether gastric lavage removes poison adequately or not
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