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Are you going to pump my child’s stomach?

Posted: June 25th, 2013 | Tags: , , , , , | No Comments »

stomach_pump_28272_lgI can’t believe that I am still getting this question from the parents of adolescent ER patients who have overdosed on medications or drugs.  “Pumping a stomach” ( also known by the fancy medical term gastric lavage )  was commonplace in the 1960’s to the early 1990’s, but has not been used extensively in nearly 20 years by most practitioners.

In 1822, British surgeon Edward Jukes, ingested a tincture of opium and then washed out his own stomach with a 1/2-inch tube to show the world that if a poison is in the stomach and is immediately taken out, significant toxicity can be avoided.  Personally, I am not sure that I would trust the conclusions of anyone who would do that to themselves.

For better or for worse, for decades (centuries really), gastric lavage was considered a viable option for treating toxic ingestions; the concept makes sense – if the poison is in the stomach and it is removed, the patient will not be poisoned anymore.

There are however some great ideas in theory that are useless, and maybe even harmful, when put into clinical practice.  Evidence-based medicine was defined by Greenhalgh and Donald as “the use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis, investigation or management of individual patients.” Translated, that means that procedures should have data showing they are safe and that they work before they become a standard clinical practice.

After 150 years of common and accepted use of the procedure, it was decided to see if pumping a stomach actually made a difference in clinical outcome. Did it actually prevent the toxic effects of a poison? What were the complications of the procedure?

Interestingly, multiple studies showed that there was really little benefit; death or significant toxicity were not prevented in the group that had their stomachs pumped when compared to the group that did not.

In a review paper published in the Journal of Clinical Toxicology in March of this year, the conclusion was:

At present there is no evidence showing that gastric lavage should be used routinely in the management of poisonings. Further, the evidence supporting gastric lavage as a beneficial treatment in special situations is weak, as is the evidence to exclude benefit in all cases. Gastric lavage should not be performed routinely, if at all, for the treatment of poisoned patients.

This is the same recommendation since 1997 from the same journal and similar expert panels.

So that’s my answer the next time a parent asks “Are you going pump my child’s stomach?”

I still have to work on a standard answer to the occasional follow up question-“Well, even if it doesn’t work, can you do it anyways to teach them a lesson so they never do it again?”

Please contact the IPC at 1-800-222-1222 for any questions about a potential poisoning. Don’t forget to check out the “My Child Ate…” resource center which gives toxicity level and treatment information for the most common substances/products ingested by children.  Click here for more information on general poison prevention.

Have a safe holiday!

Mike

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Related posts:

  1. Introducing The ‘My Child Ate’ Web Resource Library
  2. “My Child Ate…!” Honorable Mentions
  3. “My Child Ate…Poop!”
  4. “My Child Ate…Grandma’s Medicine”
  5. “My Child Ate… Nature!”


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