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Gastric lavage in iron overdose
  1. Stuart Teece, Research Fellow,
  2. Ian Crawford, Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK;
  1. kevin.mackway-jones{at}man.ac.uk

Abstract

A short cut review was carried out to establish whether gastric lavage is of use after an overdose of ionic compounds. Altogether 74 papers were found using the reported search but none answered the question posed.

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Report by Stuart Teece,Research FellowSearch checked by Ian Crawford, Research Fellow

Clinical scenario

A 29 year old woman presents to the emergency department 30 minutes after swallowing 40 lithium tablets. Given the recent onset and the apparent low efficacy of activated charcoal in ionic compounds you wonder whether she is a candidate for gastric lavage.

Three part question

In [overdose with ionic compounds] is [gastric lavage better than no treatment] at [reducing toxicity]?

Search strategy

Medline 1966–01/02 using the Ovid interface. [exp irrigation OR lavage.mp OR exp gastric lavage OR gastric lavage.mp OR exp gastric emptying OR gastric emptying.mp OR washout.mp] AND [(exp iron OR iron.ar OR exp iron compounds OR exp ferrous compounds OR ferrous.ar OR exp ferric compounds OR ferric.ar)] AND [exp poisoning OR poisons.ar OR exp overdose OR overdose.mp OR exp suicide OR exp suicide, attempted OR exp self-injurious behaviour OR suicid$.ar OR deliberate adj5self adj5harm.ar OR dsh.ar] limit to human and English.

Search outcome

Altogether 56 papers were found, none of which were relevant to the three part question.

Comment

More research is needed.

▸ CLINICAL BOTTOM LINE

There is no currently available evidence to support the use of gastric lavage in iron overdose. Local advice should be followed.

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