Gastric Lavage in Poisoning or Overdose Management

Contraindications and Risks

Gastric lavage should not be performed in cases of corrosive ingestions, as it can cause severe tissue damage and perforation, according to Praxis Medical Insights guidelines 1
The American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists recommend against the routine use of gastric lavage due to lack of proven benefit and potential risks, including aspiration pneumonia and dysrhythmias, although the specific recommendation is not provided in the given citations, similar guidelines are provided by Praxis Medical Insights 2

Activated charcoal is the preferred decontamination method over gastric lavage in most poisoning cases, and should be administered within 2 hours of ingestion, according to Praxis Medical Insights guidelines 2
The standard dose of activated charcoal is 1-2 g/kg body weight, although it is not effective for certain substances such as iron, lithium, and alcohols, as recommended by Praxis Medical Insights guidelines 2

In cases of ethylene glycol poisoning, gastric lavage was performed in only 10.5% of patients, highlighting the limited use of this procedure in clinical practice, as reported in Critical Care journal 3, 4
The American College of Medical Toxicology and other organizations emphasize the importance of securing the airway before attempting any decontamination method, including gastric lavage, although the specific citation is not provided, similar guidelines are provided by Praxis Medical Insights 2, 5

The American Society of Anesthesiologists recommends that gastric lavage should only be considered in extremely severe cases of intoxication, where the patient has ingested a potentially lethal amount, presents within 1-2 hours, has a protected airway, and trained personnel are available 6
The American Society of Anesthesiologists notes that gastric lavage is associated with significant risks, including hypoxia, cardiac arrhythmias, laryngospasm, esophageal or gastric perforation, aspiration pneumonia, accidental tracheal intubation, and electrolyte imbalances 6

The American Society of Anesthesiologists states that gastric lavage has extremely limited utility in children, and if absolutely necessary, a large-caliber orogastric tube (24-28 French) should be used, with a higher risk of complications due to smaller airway size 6