Poisoned patient - Do not perform forced emesis

Non-toxic ingestion?
No Gastric Lavage
GI Decontamination contraindicated? Yes
No Activated Charcoal
(refer to book)

No Gastric Lavage
Paracetamol poisoning?
Yes No Activated Charcoal
Refer page 219
Give methionine

Activated
Charcoal

Oleander poisoning? Consider Gastric Lavage 50 g or 1g/kg body weight

Yes
Refer page 281 Give Activated charcoal Refer pages 3-4*

Method of
Administration

Suspend In 4ml of
Consider Gastric Lavage water per gram of
Paraquat poisoning?
Yes Give Fullers earth or Charcoal orally or
Refer page 52
Activated charcoal by naso-gastric tube

No Gastric Lavage
Give Activated charcoal
Other drug poisoning? Yes if less than two hours
since ingestion or
‘slow-release ‘drug

Is the airway protected? Intubation

No If unstable,
Is the patient consenting?
Pesticide poisoning? Yes Not struggling? Resuscitate
Clinically stable? and
Refer page 5* Reassess

Yes
Gastric lavage
Procedure
•Patient placed in the Left
Lateral head down position
Gastric Lavage •Gastric Lavage using
Using Nasogastric Naso-gastric tube
Tube, then •Aspirate stomach,
Activated Charcoal •Then 300ml fluid cycles
Refer pages 4-7* •Maximum three cycles

Contraindications
•Bradycardia
•Corrosive ingestion
•Petroleum products
* Management of Poisoning
•Known oesophageal disease
Third revised edition 2007 by
Professor Ravindra Fernando
Department of Forensic Medicine and Toxicology, Faculty of Medicine, Colombo.
Sponsored by North Central Province Health &South Asian Clinical Toxicology Research Collaboration.