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At least 55 records · Page 3Linked to original sources
PubMed1985

Iced gastric lavage for treatment of heatstroke: efficacy in a canine model.

This study was undertaken to evaluate a central cooling technique for heatstroke, gastric lavage with iced tap water, for speed of cooling and efficacy of treatment in an anesthetized canine heatstroke model. Eleven mongrel dogs were anesthetized, shaved, and externally heated until core temperature reached 43.0 C (109.4 F). Control animals (n = 6) were cooled passively in room air. Treatment animals (n = 5) were cooled with the addition of gastric lavage with iced tap water through a large-bore orogastric tube. Temperatures were monitored using thermocouples in the brain, pulmonary artery, rectum, and subcutaneous tissue of the chest wall. Serial enzymatic and hematologic laboratory studies and hemodynamic parameters were measured prior to heating, at the end of heating, and at 0, 0.5, 1, 2, and 12 hours after heating. Animals were sacrificed 12 hours after heatstroke induction and gross and microscopic pathologic examination was performed. Central cooling rates achieved in the lavage group were five to six times faster than in the control group, (P less than .01) and are comparable with those reported in the literature for external cooling techniques. No significant complications were induced by tap water lavage. Rapid cooling in the lavage group resulted in a statistically significant improvement in serum creatinine and LDH after heatstroke induction (P less than .05). Gastric lavage with iced tap water appears to be an effective alternative or adjunctive cooling technique for heatstroke in the dog.

Animals↗
PubMed1990

A comparison of the efficacy of gastric lavage, ipecacuanha and activated charcoal in the emergency management of paracetamol overdose.

The aim of this prospective trial was to compare the efficacy of gastric lavage, activated charcoal and ipecacuanha at limiting the absorption of paracetamol in overdose and to assess the significance of the continued absorption of paracetamol following treatment. Patients aged 16 and over who had ingested 5 gms or more of paracetamol within 4h of admission were entered into the trial. The percentage fall in plasma paracetamol level was used as the measure of the success of a treatment at limiting absorption. The mean percentage fall was 39.3 for gastric lavage, 52.2 for activated charcoal and 40.7 for ipecacuanha, with a significant difference between the treatment methods (p = 0.03). Activated charcoal was more effective at limiting the absorption of paracetamol following overdose than either gastric lavage or ipecacuanha induced emesis. In treated patients continuing paracetamol absorption is not significant if more than 2h have elapsed since ingestion.

Absorption↗
PubMed1987

Evaporation versus iced gastric lavage treatment of heatstroke: comparative efficacy in a canine model.

We compared the speed of cooling and treatment efficacy for evaporative cooling vs. iced gastric lavage in a canine heatstroke model. Nine random-source, mongrel dogs were anesthetized, shaved, and internally heated until the core temperature reached 43.0 degrees C. The animals were then randomly assigned to be cooled to 37 degrees C either by iced (1 degree C) tap water gastric lavage (n = 5200 ml/min) through a large (32-Fr) orogastric tube, or by spraying with tap water (n = 4, 15 degrees C, 12 L/min) before a large fan blowing room temperature air (23 degrees C) across the dog at 0.5 m/sec from a height of 50 cm. Temperatures were monitored by thermocouples in both tympanic membranes and the pulmonary artery. BP, pulse, and cardiac output were measured every 5 min. Evaporative cooling was twice as fast as iced gastric lavage (0.16 +/- .05 degree vs. 0.08 +/- .01 degree C/min X m2, p less than .01). Animals in the evaporatively cooled group also experienced a quicker and more complete return to baseline cardiac indices than the lavage-treated group. Moreover, all animals treated with evaporation survived and were neurologically intact 48 h later, while only one lavage-treated dog was neurologically intact over the same period. The others in the lavage group died one hour after cooling (n = 1), were grossly ataxic (n = 1), or were persistently comatose (n = 2). A simple evaporative cooling technique, readily available in the emergency department, appears to be the most rapid and effective means for cooling and treating heatstroke in the dog.

Animals↗
PubMed1997

Position statement: gastric lavage. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Gastric lavage should not be employed routinely in the management of poisoned patients. In experimental studies, the amount of marker removed by gastric lavage was highly variable and diminished with time. There is no certain evidence that its use improves clinical outcome and it may cause significant morbidity. Gastric lavage should not be considered unless a patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 minutes of ingestion. Even then, clinical benefit has not been confirmed in controlled studies. Unless a patient is intubated, gastric lavage is contraindicated if airway protective reflexes are lost. It is also contraindicated if a hydrocarbon with high aspiration potential or corrosive substance has been ingested.

Acetaminophen↗
PubMed1986

Esophageal tear following forceful removal of an impacted oral-gastric lavage tube.

We report an unusual complication of oral-gastric lavage in a drug overdose patient. During the lavage procedure, the oral-gastric tube became impacted in the esophagus. Forceful removal of the tube resulted in an esophageal tear. The patient did well with conservative management and was discharged with no long-term sequelae.

Administration, Oral↗
PubMed1986

Management of oral-gastric lavage tube impaction of the esophagus.

Oral-gastric lavage is an important tool in the management of oral toxic ingestions. An unusual complication of the impaction of the oral-gastric tube in the esophagus is described. This is the first report of the use of flexible endoscopy in the management of the complication.

Adolescent↗
PubMed2002

Activated charcoal alone or after gastric lavage: a simulated large paracetamol intoxication.

AIMS: Activated charcoal is now being recommended for patients who have ingested potentially toxic amounts of a poison, where the ingested substance adsorbs to charcoal. Combination therapy with gastric lavage and activated charcoal is widely used, although clinical studies to date have not provided evidence of additional efficacy compared with the use of activated charcoal alone. There are also doubts regarding the efficacy of activated charcoal, when administered more than 1 h after the overdose. The aim of this study was to examine if there was a difference in the effect of the two interventions 1 h post ingestion, and to determine if activated charcoal was effective in reducing the systemic absorption of a drug, when administered 2 h post ingestion. METHODS: We performed a four-limbed randomized cross-over study in 12 volunteers, who 1 h after a standard meal ingested paracetamol 50 mg kg(-1) in 125 mg tablets to mimic real-life, where several factors, such as food, interfere with gastric emptying and thus treatment. The interventions were activated charcoal after 1 h, combination therapy of gastric lavage followed by activated charcoal after 1 h, or activated charcoal after 2 h. Serum paracetamol concentrations were determined by h.p.l.c. Percentage reductions in the area under the curve (AUC) were used to estimate the efficacy of each intervention (paired observations). RESULTS: There was a significant (P<0.005) reduction in the paracetamol AUC with activated charcoal at 1 h (median reduction 66%, 95% confidence intervals 49, 76) compared with controls, and a significant (P<0.01) reduction for gastric lavage followed by activated charcoal at 1 h (median reduction 48.2%, 95% confidence interval 32.4, 63.7) compared with controls. There was no significant difference between the two interventions (95% confidence interval for the difference -3.8, 34.0). Furthermore, we found a significant (P<0.01) reduction in the paracetamol AUC when activated charcoal was administered 2 h after tablet ingestion when compared with controls (median 22.7%, 95% confidence intervals 13.6--34.4). CONCLUSIONS: These results suggest that combination treatment may be no better than activated charcoal alone in patients presenting early after large overdoses. The effect of activated charcoal given 2 h post ingestion is substantially less than at 1 h, emphasizing the importance of early intervention.

Acetaminophen↗
PubMed1987

Changes in cardiorespiratory function during gastric lavage for drug overdose.

Cardiorespiratory function in 42 patients admitted to the Regional Poisoning Treatment Centre, Edinburgh who underwent gastric lavage for self poisoning, was studied using an electrocardiograph and an ear oximeter. Mean pulse rate rose from 92 to 121 beats per min and the mean partial pressure of oxygen fell from 95 to 80 mmHg during lavage (P less than 0.001). These changes were significantly greater in conscious than unconscious patients, in smokers than in non-smokers and most marked in male smokers aged 45 or older. No sex or age differences were noted. Electrocardiograph changes were noted in 41% of patients, including potentially serious changes in 2 patients. The indications for gastric lavage should probably be reviewed particularly in conscious older patients who smoke and due consideration given to induced emesis and ingestion of activated charcoal as alternatives.

Adolescent↗
PubMed1981

Modifications in the technique of gastric lavage.

A simple experimental model was used to demonstrate the effects of water temperature and mechanical agitation in removing pills during gastric lavage. It was nearly impossible to remove pills from an artificial stomach using room temperature water and no mechanical agitation, Using warm tap water and repetitive compressions of the artificial stomach, the pills were consistently removed with ease. We recommend that gastric lavage for poisoning victims include two phases, the first using traditional lavage technique, and the second using larger aliquots, warm lavage fluid, and massage of the epigastrium.

Gastric Lavage↗
PubMed1984

Comparison of activated charcoal and gastric lavage in the prevention of aspirin absorption.

Effectiveness of initial treatment of aspirin (ASA) overdosage was evaluated by comparing treatment with activated charcoal (AC) to treatment with gastric lavage in combination with AC. Dogs were used as subjects in four experimental groups. All subjects were administered an overdose of 500 mg/kg of ASA. Treatment was performed 30 minutes later on all groups except controls. Treatment with AC alone resulted in a 17% reduction (P greater than .05) of peak plasma salicylate levels compared with controls. When lavage preceded administration of AC, a 37% reduction (P less than .05) occurred. There was a 48% reduction (P less than .025) in plasma salicylate levels when lavage was preceded and followed by administration of AC. This study demonstrates that gastric lavage in combination with AC is more effective in reducing ASA absorption than AC given alone.

Animals↗
PubMed1987

[Failure of gastric lavage in severe drug poisoning. Value of esophagogastric fibroscopy].

A case is reported of massive drug self-poisoning (more than 200 pills associated with slices of oranges) in which repeated gastric lavage failed to empty the stomach. An attempt to split up the amalgamated pills, adherent to the gastric mucosa, by fibre-optic gastroscopy failed and a gastrotomy was required. Endoscopy together with gastric lavage is indicated in certain situations to quickly empty the stomach and so shorten the course of the poisoning. Indications are the large number of pills swallowed, a poor result of the treatment, a worsening of the clinical condition despite treatment, and three positive gastric toxicological assays within the first 24 h.

Amitriptyline↗
PubMed1991

Residual gastric content after gastric lavage and ipecacuanha-induced emesis in self-poisoned patients: an endoscopic study.

Flexible endoscopy was used to assess the intragastric residue after either ipecacuanha-induced emesis or gastric lavage in 30 self-poisoned patients. Of the 13 patients treated by induced-emesis, five (38.5%) had residual solid in the stomach; 17 patients were treated by gastric washout, and 15 (88.2%) of these had residual intragastric solid. The study provides direct evidence that the gastric decontaminating procedures employed, and especially gastric lavage, do not remove stomach contents completely.

Adolescent↗
PubMed1991

Changes in arterial oxygen tension after gastric lavage for drug overdose.

1. Changes in arterial oxygen tension after gastric lavage were investigated in a prospective study of 55 patients admitted for drug overdose. 2. A significantly greater decrease was observed in smokers compared to non-smokers. 3. A correlation was found between the tricyclic antidepressant serum level and the observed oxygen tension decrease. 4. The usefulness, as well as the safety of the lavage procedure, in managing tricyclic antidepressants overdoses is controversial.

Adolescent↗
PubMed1981

Studies on the efficacy of gastric lavage as practiced in a large metropolitan hospital.

The efficacy of gastric lavage as it is practiced in a major metropolitan hospital was evaluated. From a population of 76 patients with chemical evidence of sedative-hypnotic drugs in the blood, two or more therapeutic doses were recovered from 15.8% of the lavage samples, and 10 or more therapeutic doses were recovered from 6.6%. In a population consisting of patients with detectable quantities of drugs in the lavage sample, diazepam and amitriptyline are more adequately recovered than the sedative-hypnotic drugs. Very poor recoveries were obtained in patients lavaged more than 2 h after ingestion except in cases of amitriptyline overdose or massive sedative-hypnotic ingestion. The study indicates that inadequate criteria are employed in selecting patients most likely to benefit from lavage. Dose, time since ingestion, and symptomatology are discussed as criteria for selection of patients for lavage.

Amitriptyline↗
PubMed1982

[Respective roles of gastric lavage, haemodialysis, haemoperfusion, diuresis and hepatic metabolism in the elimination of a massive meprobamate overdose (author's transl)].

A case of massive meprobamate intoxication (100 g) is reported. On admission, 8 hours later, the plasma meprobamate level was 460 mg/l. The initial shock (hours 8-12) was successfully treated with blood volume expansion and dobutamine. The plasma meprobamate level, which was 340 mg/l when haemodialysis and haemoperfusion were started, fell to 110 mg/l at the end of the treatment. Recovery was uneventful. The amounts of drug eliminated by each method were as follows: (a) gastric lavages at 8 and 26 hours: 66 g; (b) haemodialysis (18-29 hours): 8.5 g; (d) haemoperfusion on Hemopur-charcoal (20-28 hours): 7.5 g (as measured by elution); (e) diuresis (26 hours): 2 g. It may be concluded from these data that sizeable amounts of drug can be extracted by haemodialysis and haemoperfusion, that gastric lavage remains the least invasive and most rewarding method of elimination, and that the role of hepatic metabolism in detoxication has to be taken into account.

Adult↗
PubMed2004

[Gastric lavage, hemodialysis and specific antidotes in acutely poisoned patients treated at the Specialist Hospital in Biała Podlaska (1993, 2001 and 2002)].

Gut decontamination, the methods of extracorporeal elimination of poisons and antidote use are the specific measures in clinical toxicology. Statistically they are not often used in intoxicated patients. It is not known, in how many cases of poisoning treated outside toxicological units are they applied. Approximately 110 poisoned patients were hospitalised each year in the Specialist Hospital in Biała Podlaska in years 1993, 2001 and 2002. Gastric lavage was performed in about 50 percent of those cases, especially often in children up till third year of life and in the cases of poisoning with medical drugs. The Gut Decontamination Position Statement of AACT and EAPCCT, published in 1997, had no significant impact on use of decontamination procedures in our hospital. Haemodialyses were performed in 3-5% of poisoned patients. All those patients were poisoned with ethylene glycol or methanol. Only 4 specific antidotes were used in years 1993, 2001 and 2002. The most commonly used antidote was ethanol, despite its level is not measured in our laboratory. Recommendations for gut decontamination should be widely popularised. The use of activated charcoal may be in many cases more suitable as a gastric lavage. Safe and effective use of ethanol as an antidote in a hospital requires its measuring in own laboratory.

Acute Disease↗