Elsevier

The Journal of Emergency Medicine

Volume 7, Issue 4, July–August 1989, Pages 373-377
The Journal of Emergency Medicine

Selected topic
Recovery of cyclic antidepressants with gastric lavage

https://doi.org/10.1016/0736-4679(89)90309-0Get rights and content

Abstract

The role of lavage fluid volume in recovery of cyclic antidepressant with gastric lavage was determined in 13 patients treated for moderate to severe cyclic antidepressant intoxication. An orogastric tube was placed, gastric contents aspirated, and gastric lavage performed with 60 to 180 mL aliquots of tap water or 0.9% NaCl for irrigation. A volume of 12.8 ± 4.4 liters of lavage fluid was instilled, and 97.6 ± 6.9% of this volume was recovered. The recovered aspirate and lavage fluid were inspected for the presence of particulate matter and saved in 4 to 5 liter collections. Determination of cyclic antidepressant and metabolite concentrations was performed using gas chromatography-mass spectrometry, and the amount of cyclic antidepressant recovered was calculated. The mean total amount recovered was 110 mg and ranged from 2.4 mg to 342 mg. Of the total amount recovered, 88% ± 13% was recovered in the first 4 to 5 liters of lavage fluid. An estimate of the dose ingested was available in 7 patients, with 8.7% (0.4% to 21.7%) of the estimated dose recovered by lavage. There were no cases of significant drug recovery in clear lavage fluid. We conclude that if gastric lavage is undertaken in cyclic antidepressant intoxications, it should utilize 5 liters initially and then continue only if particulate matter is seen.

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This work was performed at the Emergency Department, Medical Center Hospital, San Antonio, Texas and was presented at the AACT/AAPCC/ABMT/CAPCC Annual Scientific Meeting, August 1985, Kansas City, Missouri.

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