Gastrointestinal decontamination in the acutely poisoned patient

OBJECTIVE: To define the role of gastrointestinal (GI) decontamination of the poisoned patient. DATA SOURCES: A computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources. STUDY SELECTION AND DATA EXTRACTION: Clinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient. DATA SYNTHESIS: 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. CONCLUSIONS: The current literature supports limited use of GI decontamination of the poisoned patient.