Original contribution
Management of acutely poisoned patients without gastric emptying

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During an 18-month period, 592 acute oral drug overdose patients were studied prospectively in a controlled, randomized fashion to determine the efficacy of gastric emptying procedures in altering clinical outcome. Patients presenting on even-numbered days had no gastric emptying procedures performed, and they were compared to patients presenting on odd-numbered days who received either syrup of ipecac or gastric lavage. Patients were carefully followed for evidence of subsequent clinical improvement or deterioration after initial management. Syrup of ipecac did not significantly alter the clinical outcome of patients who were awake and alert on presentation to the emergency department (ED). Gastric lavage in obtunded patients led to a more satisfactory clinical outcome (P < .05) only if performed within one hour of ingestion. Gastric emptying procedures in the ED for initial treatment of drug overdose are generally not of benefit unless gastric lavage is performed within one hour of ingestion in obtunded patients.

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      Citation Excerpt :

      Gastric emptying studies in volunteers provide no support for the use of gastric lavage. In the single clinical study in which benefit was claimed for lavage within 1 hour of overdose,2 patients also received activated charcoal. There was also selection bias, and hence conclusions based on these data are limited.

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    Preliminary data were presented at the International Congress of Clinical Toxicology, Snowmass, Colorado, August 1982. The completed study was presented at the American Association of Poison Control Centers, American Academy of Clinical Toxicology, American Board of Medical Toxicology Annual Scientific Meeting in Boston, Massachusetts, August 1983.

    Dr Kulig is supported by a grant from McNeil Consumer Products Company.

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