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Three Part Question

[In overdose of lithium salts] is [gastric lavage better than charcoal or nothing] at [reducing toxicity]

Clinical Scenario

A 25 year old television producer with bipolar disorder attends the emergency department after taking his months supply of lithium carbonate over the last two hours. They are not sustained release tablets.You wonder whether gastric lavage would be of benefit.

Search Strategy

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.

Search Outcome

Altogether 20 papers were found all of which failed to answer the three part question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

There is no currently available clinical evidence to support the use of gastric lavage in lithium overdose. UK poisons centre advice (1) suggests that gastric lavage should be considered for non-sustained-release preparations if more than 4 g has been ingested by an adult within 1 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 (1) should be followed.

References

1. Toxbase. http://www.spib.axl.co.uk/