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Three Part Question

In [arsenic overdose]is [gastric lavage better than activated charcoal or nothing] at [reducing absorption]

Clinical Scenario

A 35 year old industrial chemist attends the emergency department having taken 2g of trivalent arsenic. You have read that charcoal is poor at removing ionic compounds and wonder whether he may benefit from gastric lavage.

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 suicide, attempted OR exp self-injurious behavior OR poiso$.af OR overdos$.af OR suicid$.af OR (deliberate adj5 self adj5 harm).af OR dsh.af] AND [exp arsenic OR exp arsenic poisoning OR arsenic.af OR arse$.af OR as+.af or as2+.af]) LIMIT to human AND English language.

Search Outcome

Altogether 12 papers were found, one of which is a case report of arsenic poisoning none of the other papers were relevant to 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)

The one available case report concerned a patient who attended 4 hours after ingestion 5g trivalent arsenic. A total of 65 lavages were carried out over 7 days using normal saline and alkaline irrigation. Analysis of the 120.6 litres of recovered lavage fluid showed <1% of the amount ingested had been recovered during this period and gastroscopy at 7 days showed agglomerates in the stomach. Despite this being the only report it's results point strongly to gastric lavage being of limited use in arsenic poisoning.

Editor Comment

For UK position statement on gastric lavage see http://www.spib.axl.co.uk/toxbaseindex.htm

Clinical Bottom Line

There is little evidence for gastric lavage in arsenic overdose and the little which does exist suggests it is of negligible value.

References

1. Michaux I, Haufroid V, Dive A,et al. Repetitive Endoscopy and Continuous Alkaline Gastric Irrigation in a Case of Arsenic Poisoning. J Toxicol Clin Toxicol 2000;38(5):471-476.