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Gastrointestinal decontamination of the poisoned patient

Robert G Hendrickson, MD
Shana Kusin, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Gastrointestinal decontamination refers to the practice of functionally removing an ingested toxin from the gastrointestinal (GI) tract in order to decrease its absorption. Historically, many approaches have been adopted, including gastric evacuation (forced emesis or gastric lavage), intra-gastric binding (most commonly by single or multidose activated charcoal), or speeding transit of toxins to decrease total absorption time (whole bowel irrigation or cathartics). As clinical practice has evolved and understanding of the efficacy, risks, and benefits of decontamination have grown, many practices have fallen out of favor.

This topic provides an overview of the approach to gastrointestinal decontamination in poisoned patients and a review of the evidence supporting the approach described. The management of intoxication with specific agents and general management of the poisoned patient, including children, are reviewed separately. (See "General approach to drug poisoning in adults" and "Initial management of the critically ill adult with an unknown overdose" and "Approach to the child with occult toxic exposure".)


No controlled clinical studies have demonstrated that the “routine” use of gastrointestinal (GI) decontamination reduces morbidity and mortality in poisoned patients. However, evidence from human volunteer trials and clinical studies suggest that decontamination may reduce the absorption of toxins in the GI tract and may be helpful in select circumstances [1-3].

The decision to perform GI decontamination is based upon the specific poison(s) ingested, the time from ingestion to presentation, presenting symptoms, and the predicted severity of poisoning. GI decontamination is most likely to benefit patients who:

Present for care soon after ingestion (usually within one to two hours)

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Literature review current through: Nov 2017. | This topic last updated: Jan 24, 2017.
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