Table 2
Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Underhill TJ et al, 1990, UK60 patients taken 5 g or more within 4 hours of attendance. Gastric lavage (14) v ipecacuanha(21) v activated charcoal(20) or nothing(5)RCTPlasma concentrations at 0, 1.0, 1.5. and 2.5 hours after treatment39.3% reduction in concentration compared with 52.2% charcoalSmall Study
Buckley NA et al, 1999, Australia981 consecutive paracetamol overdose. Gastric lavage and charcoal v charcoal alone v nothingObservational studyPatients developing high risk concentrationsNo statistically significant improvement with lavage + charcoal than charcoal alone.
Grierson R et al 2000, Canada10 volunteers given 4.0 g paracetamol. Gastric lavage at 1 hour compared with no treatment as crossover.Crossover study8 plasma concentrations over 8 hoursReduction of 20% (95% CI 3% to 37%)Small study. Low dose. Liquid paracetamol only
Christophersen AB et al, 2002, Denmark12 volunteers given 50 mg/kg paracetamol. Lavage + charcoal v charcoalCrossover study12 plasma concentrations over 7 hoursCharcoal 66% reduction in concentration, lavage + charcoal 48.2%Small numbers Low dose