Analysis of Gastric Lavage Reported to a Statewide Poison Control System.
BACKGROUND
As decontamination trends have evolved, gastric lavage (GL) has become a rare procedure. The current information regarding use, outcomes, and complications of GL could help refine indications for this invasive procedure.


OBJECTIVE
We sought to determine case type, location, and complications of GL cases reported to a statewide poison control system.


METHODS
This is a retrospective review of the California Poison Control System (CPCS) records from 2009 to 2012. Specific substances ingested, results and complications of GL, referring hospital ZIP codes, and outcomes were examined.


RESULTS
Nine hundred twenty-three patients who underwent GL were included in the final analysis, ranging in age from 9 months to 88 years. There were 381 single and 540 multiple substance ingestions, with pill fragment return in 27%. Five hundred thirty-six GLs were performed with CPCS recommendation, while 387 were performed without. Complications were reported for 20 cases. There were 5 deaths, all after multiple ingestions. Among survivors, 37% were released from the emergency department, 13% were admitted to hospital wards, and 48% were admitted to intensive care units. The most commonly ingested substances were nontricyclic antidepressant psychotropics (n = 313), benzodiazepines (n = 233), acetaminophen (n = 191), nonsteroidal anti-inflammatory drugs (n = 107), diphenhydramine (n = 70), tricyclic antidepressants (n = 45), aspirin (n = 45), lithium (n = 36), and antifreeze (n = 10). The geographic distribution was clustered near regions of high population density, with a few exceptions.


CONCLUSIONS
Toxic agents for which GL was performed reflected a broad spectrum of potential hazards, some of which are not life-threatening or have effective treatments. Continuing emergency physician and poison center staff education is required to assist in patient selection.
Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, California.
Jimmy
J
Donkor
Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, California.
Patil
P
Armenian
Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, California.
Isaac N
IN
Hartman
Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, California; California Poison Control System, Fresno-Madera Division, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, Madera, California.
Rais
R
Vohra
D000082:Acetaminophen / Q000506:poisoning; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000506:poisoning; D000928:Antidepressive Agents / Q000506:poisoning; D001569:Benzodiazepines / Q000506:poisoning; D002140:California; D002648:Child; D002675:Child, Preschool; D004155:Diphenhydramine / Q000506:poisoning; D062787:Drug Overdose / Q000209:etiology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005751:Gastric Lavage / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D011041:Poisoning / Q000209:etiology / Q000628:therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D001569:Benzodiazepines; D000082:Acetaminophen; D004155:Diphenhydramine
decontamination; gastric lavage; geomapping; poison control center