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Gastric lavage in aspirin and non-steroidal anti-inflammatory drug overdose
  1. Stewart Teece, Clinical Research Fellow,
  2. Ian Crawford, Clinical Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether gastric lavage was better than activated charcoal alone at reducing toxicity after aspirin or other non-steroidal anti-inflammatory drug (NSAID) overdose. Altogether 72 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. A further relevant paper was found on scanning the references of papers identified. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

    • gastric lavage
    • aspirin
    • overdose
    • non-steroidaly anti-inflammotory drug

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    Report by Stewart Teece, Clinical Research FellowChecked by Ian Crawford, Clinical Research Fellow

    Clinical scenario

    A 53 year old widow attends the emergency department having taken 20 aspirin and 20 ibuprofen 1.5 hours previously. You remember that NSAIDs slow gastric emptying and wonder whether gastric lavage would be of use in toxicity reduction.

    Three part question

    [In overdose with aspirin or other non-steroidal anti-inflammotory drugs] is [gastric lavage better than activated charcoal] at [reducing toxicity]?

    Search strategy

    Medline 1966-05/04 using the Ovid interface. [{exp gastric lavage OR gastirc lavage.mp OR exp gastric emptying OR gastric emptying.mp OR exp irrigation OR lavage.mp OR empt$.mp OR irrigat$.af OR washout.af OR wash-out.af} AND {exp poisoning OR exp overdose OR exp suicide OR exp Self-Injurious Behavior/OR poiso$.af OR overdos$.af OR suicid$.af OR (deliberate adj5 self adj5 harm).af OR dsh.af} AND {exp aspirin OR exp anti-inflammatory agents, non-steroidal OR salic$.af OR nsaid.mp OR ketoprofen.af OR diclofenac.af OR aceclofenac.af OR acemetacin.af OR azapropazone.af OR celecoxib.af OR dexketoprofen.af OR diflunisal.af OR etodolac.af OR fenbrufen.af OR fenoprofen.af OR flurbiprofen.af OR indometacin.af OR indomethacin.af OR ketoprofen.af OR mefenamic acid.af OR meloxicam.af OR nabumetone.af OR naproxen.af OR phenylbutazone.af OR piroxicam.mp OR exp piroxicam OR rofecoxib.af OR sulindac.af OR tenoxicam.af OR tiaprofenic acid.af}] LIMIT to human AND English language.

    Search outcome

    Altogether 72 papers were found 71 of which failed to answer the three part question. A further reference was found after scanning of paper references. The two papers are shown in the table 6.

    Table 6

    Comment(s)

    There are no large scale trials performed in this area, however those that exist show that at best lavage is no better if not slightly worse than charcoal at reducing salicylate toxicity. Lavage although better than nothing has an element of risk involved in its practice and charcoal must therefore be treatment of choice.

    CLINICAL BOTTOM LINE

    Gastic lavage is no better than charcoal alone at reducing toxicity after aspirin or NSAID overdose.

    Report by Stewart Teece, Clinical Research FellowChecked by Ian Crawford, Clinical Research Fellow

    References

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