Treatment of poisoning:Gastric lavage

1. Immediate  resuscitative  measures  :To follow  ABCD  protocal,  i.e.  mangement  of  airway, breathing, circulation and depression of CNS
2. Removal of  unabsorbed Poison: depends upon the mode of intake of the poison for eg: In Ingested Poisons:  Vomiting , gastric  lavage(stomach wash), Emesis  can be done .
3. Use  of  antidote  : Antidote  is  given  to  counteract  or neutralize the  effect of poison.
4. Elimination  of  already  absorbed poison: By  forced  diuresis (alkaline  or acid  diuresis),  dialysis  (peritoneal  dialysis  or hemodialysis).

Gastric Lavage(stomach washing):

• Gastric lavage also commonly called stomach wash or gastric suction, is the process of cleaning out the contents of the stomach. It has been used for eliminating poisons from the stomach.
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  Gastric lavage must be done (except when contraindicated) irrespective of whether vomiting has occured or not, to prevent aspiration of content

• It is  most effective  if  done  within  3-6  hours of  poisoning.
• In  gastric  lavage,  stomach  is  washed  by warm water;  1:5000  KMnO₄ ; tannic  acid;  sodium  bicarbonate;  sodium  or potassium iodide;  calcium lactate,  saturated  lime  water  or starch  solution  or 0.9%  saline.

Contradictions:

It include

1) absolute:- The  only  obsolute  contraindication  is  corrosive  poisoning, i.e.   alkalis,  mineral  acid,  vegetable  acid and organic acids  (except  carbolic  acid).

2) Relative:- Convulsants (strychnine): Only after controlling convulsions. and Kerosene or volatile poisons or comatose patients*

• Non- live threatening ingestions & non- toxic ingestions.
• Pills that are known not to fit into the holes of the gastric lavage tube.
• Any pt. whose air integrity is not assured.
• The  only  obsolute  contraindication  is  corrosive  poisoning, i.e.   alkalis,  mineral  acid,  vegetable  acid and organic acids  (except  carbolic  acid).
•  Carbolic acid is  the  only corrosive  in  which gastric  lavage  can be  used. P.M findings shows leathery stomach in case of carbolic poisoning
• Toxic  ingestions  with  more  pulmonary  than  G.I.T  Toxicity  e.g. kerosene (to avoid aspiration).

Complication:

• Insertion of the tube in to the trachea obstructing it.
• Aspiration pneumonitis,
• Esophageal or gastric perforation.
• Decreased oxygenation during the procedure.

Procedure:

• It is performed by sequentially administering and aspiring about 5ml fluid/kg of weight with 36-40 french orogastric tube(22-28 for children).
• It is repeated till clear and odourless fluid comes out. If there is any bleeding, the procedure is abandoned.
• The patient is placed in Trendelenburg
• the patient is placed in trendelenburg (mouth ias at lower level than larynxso as to aid respiratory drainage and aspiration)
• Fluid for gastric lavage:Except for infants, where normal saline is recommended, tap water is acceptable.