AbstractIt is estimated that roughly 1% of emergency department (ED) visits in the US are poisoning-related.
1 Historically, aggressive and categorical gastrointestinal decontamination (GID) was the accepted medical standard following ingestion of drugs or toxins in overdose or suspected overdose. The general principle of GID is to minimize the systemic absorption and/or decrease the gastrointestinal transit time of the ingested agent. In recent years, the routine utilization of GID in the ED has greatly diminished. Various clinical studies have consistently failed show a benefit for indiscriminate GID of the generic or undifferentiated mild to moderate overdosed patient.
2-4 In this issue of
EM Practice Guidelines Update, a body of position papers regarding GID following acute drug or toxin ingestions or exposures will be discussed.
Practice Guideline Impact
- The aggressive and routine use of GID in the generic or undifferentiated ingestion is not recommended.
- Routine out-of-hospital and ED ipecac-induced emesis is no longer recommended.
- The routine use of single-dose or multi-dose activated charcoal is not recommended in generic acute toxic ingestions.
- Gastric lavage is rarely, if ever, indicated in acute toxic ingestions.
- Whole bowel irrigation is not recommended for generic acute toxic ingestions.
