Gastric lavage

Consider if patient presents within 60 minutes of ingestion.

Insert orogastric tube.

Attempt aspiration first, followed by 100 to 200 mL normal saline, then aspiration.

Relatively contraindicated in hydrocarbon ingestion

Neurologically impaired: cuffed endotracheal tube prior to lavage

AATC/EAPCCT Position Statement: gastric lavage not routinely used in poisonings. It is indicated only When potentially life-threatening amount of poison is ingested and the procedure can be done within 60 minutes of ingestion.

Cathartics

Used only in combination with activated charcoal

Sorbitol (1 to 2 mL/kg or 70 percent solution in adults, 1.5 to 2.5 mL/kg of 35 percent solution in children)

Single dose only

Not recommended in poisonings that produce diarrhea (organophosphates, carbamates, heavy metals in particular) or those that produce ileus (paraquat and diquat)

AATC/EAPCCT Position Statement: Cathartic alone has no place in management of poisoned patient. No definite indications for use of cathartics and its routine use with activated charcoal is not endorsed. If it is used, it should be as a single dose. Numerous contraindications: absent bowel sounds, abdominal trauma or surgery, intestinal perforation or obstruction, volume depletion, hypotension, or ingestion of a corrosive substance.

Activated charcoal

Used in conjunction with a cathartic if patient presents within 60 minutes of ingestion. (Some authorities would use beyond 60 minutes if serious poisoning is suspected.)

Dose: Adults and children >12 years, 25 to 100 g in 300 to 800 mL water; children <12 years, 1 gm/kg in 300 mL water

Dose may be repeated in 2 to 4 hours if bowel sounds are present.

Antiemetic suppository for nausea

Administered by nasogastric tube if unable to tolerate or unable to swallow

Protect airway if hydrocarbon-containing pesticide or unknown pesticide contents.

AATC/EAPCCT Position Statement: Activated charcoal should not be used routinely in management of poisoned patients. Charcoal appears to be most effective within 60 minutes of ingestion and may be considered for use for this time period. There is insufficient evidence to support or deny its use beyond 60 minutes after ingestion.

Syrup of ipecac

No longer indicated for routine use

Dose: adults and children >12 years, 15 to 30 mL followed by 240 mL water; children <12 years, 15 mL preceded or followed by 120 to 240 mL water; infants six to 12 months of age, 5 to 10 mL preceded or followed by 120 to 240 mL water

Dose may be repeated in all age groups if emesis does not occur within 20 to 30 minutes.

Contraindicated in patients with diminished airway protective reflexes, ingestion of hydrocarbons with aspiration potential, ingestion of a corrosive substance, or ingestion of a substance for which advanced life support may be necessary within the next 60 minutes.

AATC/EAPCCT Position Statement: Ipecac syrup should not be administered routinely in poisoned patients. If it is used, it should be administered within 60 minutes of ingestion. Considered only in alert patients who have ingested a potentially serious toxin. Same contraindications as listed above.