Gastrointestinal decontamination in the acutely poisoned patient

A computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources.Clinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient.The literature suggests that previously, widely used, aggressive approaches including the use of ipecac syrup, gastric lavage, and cathartics are now rarely recommended. Whole bowel irrigation is still often recommended for slow-release drugs, metals, and patients who "pack" or "stuff" foreign bodies filled with drugs of abuse, but with little quality data to support it. Activated charcoal (AC), single or multiple doses, was also a previous mainstay of GI decontamination, but the utility of AC is now recognized to be limited and more time dependent than previously practiced. These recommendations have resulted in several treatment guidelines that are mostly based on retrospective analysis, animal studies or small case series, and rarely based on randomized clinical trials.The current literature supports limited use of GI decontamination of the poisoned patient.In the United States, the American Association of Poison Control Centers (AAPCC) reported about 2.4 million poisoning exposures a year in 2006, while the Institute of Medicine in 2001 estimated more than 4 million poisoning episodes with 300,000 hospitalizations and 24,173 poisoning-related deaths [1-3]. This article will review the current recommendations, guidelines and data on gastrointestinal (GI) decontamination in the poisoned patient.Gastrointestinal decontamination of the poisoned patient has evolved significantly over the last 2 1/2 decades from a very invasive to a less aggressive approach. This less aggressive approach to GI decontamination followed a series of position statements published jointly by the American Academy of Clinical Toxicology (AACT) and the European Association of Poison Centres and Clinical Toxicologists (EAPCCT) in the late 1