We thank Marx and Marx for their critical response to the consensus article on gastric lavage we cited in our CME article. Their comment is likely to find agreement with many readers.
Especially experienced colleagues will remember successful cases of gastric lavage, which in the past was often applied in treatment of oral intoxication. We also reviewed many impressive individual case reports. It seems obvious that the removed poison cannot harm the patient any longer—and that gastric lavage represents an effective treatment strategy.
On the other hand, however, we have received many case reports of poor outcomes after gastric lavage.
The consensus article under criticism was compiled by toxicologists representing two medical societies, which conducted a careful and systematic evidence-based evaluation including various sources. Their goal was to describe the best therapeutic recommendation for all poisoned patients. The position paper on gastric lavage was reviewed several times by the working groups—newly formed each time —on the basis of recent literature and was confirmed almost without changes. The recommendation to perform gastric lavage only within 60 minutes after ingestion of a life-threatening dose of a toxic agent is based on a consensus that has remained stable for 16 years.
The cited article by Good et al. was an important contribution to the discussion. The data collected in 2002 about inconsistent advice given by poisons information centers in different countries—in spite of published recommendations from medical specialty societies—have underlined the need for harmonization/standardization of the treatment recommendations. This was also the intention of our article.
Poisons information centers provide advice if gastric lavage is under consideration. They register case reports to be added to the continuing discussion of the subject and may serve as a basis for future alignments of therapeutic recommendations.
Dr. med. Dieter Müller
Dipl. Chem. Dr. rer. nat. Herbert Desel
University Medical Center Göttingen
GIZ-Nord Poisons Center
Conflict of inteest statement
Dr Müller declares that no conflict of interest existss.
Dr Desel has received payment for serving as a consultant for the International Association for Soaps, Detergents and Maintenance Products (AISE, Brussels) and for expert opinions for Henkel. AISE and Industrieverband Körperpflege und Waschmittel (German Personal Care Products and Detergents Industry Association, Frankfurt/Main) are sponsoring the multicenter research project MAGAM II coordinated by GIZ-Nord Poisons Center, managed by Dr Desel.
|1.||Müller D, Desel H: Common causes of poisoning-etiology, diagnosis and treatment. Dtsch Aerztebl Int 2013; 110: 690–700. VOLLTEXT|