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Abstract
A short cut review was carried out to establish whether gastric lavage is better than activated charcoal in cases of poisoning with paracetamol. Altogether 63 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. 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.
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Report by Stewart Teece, Clinical Research Fellow Checked by Kerstin Hogg, Clinical Research Fellow
Clinical scenario
A 26 year old woman attends the emergency department 40 minutes after having taken 80×500 mg paracetamol tablets. As the dose taken is high and within the past hour you wonder whether she would benefit from gastric lavage.
Three part question
In [paracetamol poisoning] is [gastric lavage better than activated charcoal or nothing] at [reducing hepatotoxicity]?
Search strategy
Medline 1966-10/03 using the OVID interface. [exp acetaminophen OR paracetamol.mp OR acetaminophen.mp] AND [exp poisoning OR poison$.mp OR exp overdose OR overdos$.mp] AND [exp gastric lavage OR gastric lavage.mp OR gastric decontamination.mp OR exp gastric emptying OR gastric emptying.mp OR exp irrigation OR washout.mp] LIMIT to human AND English.
Search outcome
Altogether 63 papers found of which 59 were irrelevant or of insufficient quality. Four of the remaining papers are shown in table 2, the fifth is a position statement mentioned in the comments section.
Comment(s)
The 1997 Joint Position Statement by the American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists stated gastric lavage should not be routinely used for poisoned patients. A similar statement from the British Poisons Centres indicates that gastric lavage is only to be used within 60 minutes of overdose and only with drugs not absorbed by charcoal.
CLINICAL BOTTOM LINE
Gastric lavage is less effective than charcoal alone after paracetamol poisoning.
Report by Stewart Teece, Clinical Research Fellow Checked by Kerstin Hogg, Clinical Research Fellow