Gastric lavage in acute organophosphate poison

Report By: YI LI - Attending doctor
Institution: Peking Union Medical College Hospital
Date Submitted: 30th December 2005
Last Modified: 30th December 2005
Status: Blue (submitted but not checked)

Three Part Question

In [a patient with acute organophosphate poisoning] are [gastric lavages better than no lavage] in [decreasing mortality]?

Clinical Scenario

A 40 year old man presents to the emergency department 30 minutes after drinking 500ml fenthion. He has a Glasgow Coma Scale score of 13/15, and has pinpoint pupils and excessive sweat. A rapid sequence induction and intubation is done. Given the recent onset and the undefinite efficacy of activated charcoal in organophosphate you wonder whether he is a candidate for gastric lavage.

Search Strategy

Medline 1966-01/02 using the Ovid interface.
[exp irrigation OR lavage.mp OR exp gastric lavage OR gastric lavage.mp OR exp gastric emptying OR gastric emptying.mp OR washout.mp] AND [(exp organophosphate OR organophosphate.ar)] AND [exp poisoning OR poisons.ar OR exp suicide OR exp] limit to human.

Search Outcome

Altogether 34 papers were found, none of which were relevant
to the three part question.

Comment(s)

More research is needed.

Clinical Bottom Line

There is no currently available evidence to support the use of gastric lavage in organophosphate poisoning. As outlined in the position statement paper, gastric lavage can be done within 1 hour of organophosphate ingestion. Local advice should be followed. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.Position statement: gastric lavage. J Toxicol Clin Toxicol 2004; 42:933-943.