Gastric Lavage
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.
Procedure
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
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.
Contra-indications