Jan 5, 2009: Is anything new in GI decontamination?

Although GI decontamination has been considered a mainstay of treating poisoned patients, there is no evidence that GI decontamination procedures change outcome.  Aggressive GI decontamination procedures are a product of this country-in Europe, toxicologists seldom recommend GI decontamination. The recommendations of the TN Poison Center are based on available literature and clinical experience.


Syrup of Ipecac

Induction of emesis is no longer recommended.  There is little data, but what data there is has revealed no benefit.  The AAP also put their weight behind no longer using this product.


Gastric Lavage  

Once again, little data, but available data reveals little benefit.  There is no role for gastric lavage in children less than 12 years old as the size of the tube is too small to retrieve pill fragments.  There is no data in patients who are obtunded within an hour of ingestion.


Single-Dose Activated Charcoal (SDAC)

SDAC adsorbs drugs due to its’ physiochemical properties. Adsorption of drugs onto charcoal was thought to decrease the amount of drug absorbed and thereby decrease the toxicity of the poisoning.  Little data, but there is no data to prove its benefit. Although some drugs placed in solution in beakers are adsorbed onto AC, how that absorption translates to drugs in the stomach is unknown. Charcoal aspiration was previously thought to be innocuous, but there is now evidence that the charcoal remains in the lung tissue for years and can cause chronic pulmonary problems.  The TN Poison Center seldom recommends SDAC, although it may be considered when cellular toxins (such as methotrexate or colchicine) are ingested.  Administration of SDAC is still one of the more controversial areas of GI decontamination.


Whole Bowel Irrigation

If a patient presents to the ED within 5 hours of ingestion, placing a tube into the stomach and administering 1-2 liters of golytely/hour through the tube may mechanically push pills through the GI tract.  This is most frequently considered following ingestions of sustained release preparations, iron, lithium, other ions (such as arsenic) and for body packers.  There is no data on efficacy. 


I am interested in any questions you would like answered in the Question of the Week.  Please email me with any suggestion at donna.seger@vanderbilt.edu


Donna Seger, M.D.

Medical Director

Tennessee Poison Center

Website: www.tnpoisoncenter.org