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Three Part Question

In [overdose with iron compounds] is [gastric lavage better than no treatment] at [reducing toxicity]?

Clinical Scenario

A 29 year old woman presents to the emergency department 30 minutes after swallowing 40 ferrous sulphate tablets. Given the recent onset and the apparent low efficacy of activated charcoal in iron compounds you wonder whether she 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 wash-out.mp] AND [(exp iron OR iron.mp OR exp iron compounds OR exp ferrous compounds OR ferrous.mp OR exp ferric compounds OR ferric.mp] AND [exp poisoning OR poisoning.mp OR exp overdose OR overdose.mp OR DSH.mp] LIMIT to human AND English.

Search Outcome

54 papers were found, none of which were relevant to the three part question

Editor Comment

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

Clinical Bottom Line

There is no currently available evidence to support the use of gastric lavage in the overdose of iron compounds. Local advice should be followed.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.