A short cut review was carried out to establish the published evidence for gastric lavage in lithium overdose. Altogether 20 papers were found using the reported search, of which none presented the best evidence to answer the clinical question. A clinical bottom line is stated.
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Report by Stewart Teece,Clinical Research Fellow Checked by Ian Crawford, Clinical Research Fellow
Three part question
In [overdose of lithium salts] is [gastric lavage better than charcoal or nothing] at [reducing toxicity]?
A 25 year old television producer with bipolar disorder attends the emergency department after taking his months supply of lithium carbonate over the past two hours. They are not sustained release tablets. You wonder whether gastric lavage would be of benefit.
Medline 1966–09/04 using the OVID interface. [(exp gastric lavage OR exp gastric emptying OR exp irrigation OR lavage.af OR empt$.af OR irrigat$.af OR washout.af OR wash-out.af) AND (exp poisoning OR exp overdose OR exp suicide OR exp poisoning 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 lithium OR exp lithium compounds OR exp lithium carbonate OR exp lithium chloride OR lithium.af OR Li+.af OR camcolit.af OR priadel.af OR liskonum.af OR li-liquid.af)] LIMIT to English language.
Altogether 20 papers were found all of which failed to answer the three part question.
There is no currently available clinical evidence to support the use of gastric lavage in lithium overdose. UK Poisons Centre advice (http://www.spib.axl.co.uk/) suggests that gastric lavage should be considered for non-sustained release preparations if more than 4 g has been ingested by an adult within one hour, or definite ingestion of a significant amount by a child. Lavage is thought to be of limited use in sustained release preparations as they do not disintegrate in the stomach and therefore are unlikely to be retrieved.
CLINICAL BOTTOM LINE
As there is no evidence from clinical trials national guidelines should be followed (http://www.spib.axl.co.uk/).