Admission to ICU


  • Intubated patients

  • Uncontrollable seizures

  • Coma

  • Persistent hypotension

  • ECG abnormalities consistent with significant ingestion:

      • Ventricular or supraventricular tachyarrhythmias

      • Sinus tachycardia > 140 / min

      • 2nd  or 3rd degree heart block

      • QT-prolongation (preferably index QTc)

      • QRS duration > 0.12ms


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.



  • 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.



  • Elemental metals (lithium, iron)

  • Pesticides

  • Strong acids or alkalis

  • Cyanide

  • Late presentations > 4-6 hrs post ingestion


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Page last reviewed: 13 May 2014