The place of gastric Lavage in acute poisoning is debatable, and is only of benefit in the hyper acute phase of poisoning (< 1 hour).
Patients must have intact level of consciousness and a preserved gag reflex, failing which the risks and benefits of intubating the patient need to be considered.
Insert 16G nasogastric tube (not a large bore sump)
Instil 1 ml/kg warm water only, then attempt recovery of the Lavage
Do not continue to instil water until the previous volume has been removed
Continue until Lavage is clear
Charcoal aspiration has a high morbidity and mortality. As for gastric Lavage above, this should not be attempted in patients without a safe or protected airway.
Instil 50g as soon as possible and 50g 4 hrly thereafter while indication persists. Co-administration with sorbitol has not been shown to increase effacy.
In general charcoal should be given in a ratio of 10:1, charcoal dose to drug ingested dose.
Indication for Administering Activated Charcoal
Virtually all patients presenting with a drug overdose.