Letters

Managing self poisoning

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7236.711 (Published 11 March 2000) Cite this as: BMJ 2000;320:711

Gastric lavage is perhaps more important in developing countries

  1. Madhur Dev Bhattarai, postgraduate teacher. ([email protected])
  1. Department of Medicine, Bir Hospital, Kathmandu, Nepal
  2. Accident and Emergency Department, Khoula Hospital, Muscat, Oman [email protected]
  3. Heartlands Hospital, Birmingham B9 5SS
  4. Manor Hospital, Walsall WS2 9PS
  5. Department of Therapeutics and Pharmacology, Queen's University of Belfast, Belfast BT7 1NN
  6. University Hospital Aintree, Liverpool L9 7AL
  7. Bassetlaw Hospital Trust, Worksop S81 0JN
  8. National Poisons Information Service, Guy's and St Thomas's NHS Trust, London SE14 5ER

    EDITOR—In their clinical review of recent advances in the management of self poisoning, Jones and Volans briefly discuss gastric lavage and state: “many clinical toxicologists rarely use this method now.”1 The impression given could support the abandonment of gastric lavage. This could be particularly deleterious in developing countries.

    In developing countries, poisons consumed are commonly toxins such as organophosphorus compounds and aluminium phosphide, and thus mortality is high. The organophosphorus compounds are usually consumed in liquid form. In such cases of poisoning, prevention of absorption of even a small amount may make a considerable difference. Furthermore, antidotes to poisons and intensive care may not be available. Any intervention, such as gastric lavage, which can be carried out easily cannot be neglected. The value of gastric lavage depends on the amount, toxicity, and effect of the poison and the time since consumption. Its role in certain cases should have been highlighted.

    References

    1. 1.

    Common sense makes no sense

    1. Dilip DaCruz, visiting consultant in emergency medicine.
    1. Department of Medicine, Bir Hospital, Kathmandu, Nepal
    2. Accident and Emergency Department, Khoula Hospital, Muscat, Oman [email protected]
    3. Heartlands Hospital, Birmingham B9 5SS
    4. Manor Hospital, Walsall WS2 9PS
    5. Department of Therapeutics and Pharmacology, Queen's University of Belfast, Belfast BT7 1NN
    6. University Hospital Aintree, Liverpool L9 7AL
    7. Bassetlaw Hospital Trust, Worksop S81 0JN
    8. National Poisons Information Service, Guy's and St Thomas's NHS Trust, London SE14 5ER

      EDITOR—Although Jones and Volans's article updating doctors on the management of poisoning is welcome and informative, I was a little bemused by the contradictions in it.1

      We are told that gastric lavage should not be used unless two criteria are met: it should be used within an hour of ingestion of the poison, and the amount of toxin should be substantial. Though these criteria are repeated often in the literature there is no evidence to support either of them. The literature indicates only that there is no difference in outcome when gastric lavage is used. But Jones and Volans—like the authors of the papers quoted—give way to that devil, common sense.

      It makes sense to try to remove a toxin before it is absorbed; therefore, when the poisoning may be serious, scrap the evidence, go for common sense, and do a gastric lavage. How, in real life, we …

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