Summary of American academy of clinical toxicology and european association of poison centres and clinical toxicologists position: Statements on gut decontamination

Abstract

The Position Statements on gastrointestinal decontamination were produced by the American Academy of Clinical Toxicology and the European Association over a 4-year period using agreed methodology. The Statements conclude that as the effect of syrup of ipecac diminishes with time and as there are no clinical studies to prove that ipecac improves the outcome of poisoned patients, its routine administration in the Emergency Department should be abandoned. It should be considered only if it can be administered within 60 minutes of drug ingestion to an alert conscious patient who has ingested a potentially toxic amount of a poison; even then clinical benefit has not been confirmed in controlled studies. Gastric lavage should not be employed routinely in the management of poisoned patients. There is no certain evidence that its use improves clinical outcome and it may cause significant morbidity. Gastric lavage should not be considered unless a patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 minutes of ingestion; even then clinical benefit has not been confirmed in control studies. Single-dose activated charcoal should not be administered routinely in the management of poisoned patients. On the basis of volunteer studies, the effectiveness of activated charcoal decreases with time; the greatest benefit is within 1 hour. The administration of activated charcoal may be considered if a patient has ingested a potentially toxic amount of a poison (which is known to be adsorbed to charcoal) up to 1 hour previously; there are insufficient data to support or exclude its use after 1 hour. There is no evidence that the administration of activated charcoal improves clinical outcome. On the basis of available data there are no definite indications for the use of cathartics in the management of the poisoned patient. In addition, there are no established indications for the use of whole bowel irrigation. On the basis of experimental studies, WBI is an option for potentially toxic ingestions of sustained release or enteric-coated drugs. WBI is of theoretical value in the management of patients who have ingested substantial amounts of iron and for the removal of ingested packets of elicit drugs.