Gastric emptying in acute overdose

Gastric emptying in acute overdose: a prospective randomised controlled trial

Susan M. Pond, David J. Lewis-Driver, Gail M. Williams et al.                                                                              Med J Aust 1995; 163: 345-349

OBJECTIVE: To test the hypothesis that administration of activated charcoal is as efficacious and safe as the combination regimen of gastric emptying plus charcoal in adults after acute oral overdose.
DESIGN: Prospective randomised controlled trial, with subjects presenting on odd-numbered dates allocated to the emptied group (E), and those on even-numbered dates to the not emptied group (NE).
SETTING: Princess Alexandra Hospital, Brisbane (a tertiary referral hospital), which serves an adult urban community, between 4 January 1988 and 11 June 1990.
SUBJECTS: Consecutive patients (13 years or older) who presented to the Emergency Department after ingesting an overdose of one or more compounds able to be adsorbed by activated charcoal.
INTERVENTIONS: All patients received charcoal by oral or nasogastric route. Those in the E group also had gastric emptying by ipecac-induced emesis or gastric lavage.
OUTCOME MEASURES: Clinical course during the first six hours after treatment began, length of hospital stay, complications.
RESULTS: 876 patients were eligible for the study. There were no significant differences between the E nd NE groups in age and sex distribution, severity of the overdose or other characteristics, except the mean interval between presentation and administration of charcoal (91 min [SD,52]) for E group and 55 [SD, 41] for NE group; P = 0.0001). There were no significant differences between the E and NE groups in outcome, even when the groups were stratified for severity of the overdose or into subgroups that presented sooner or later than one hour after ingestion.
CONCLUSIONS: Gastric emptying can be omitted from the treatment protocol for adults after acute oral overdose.