Safety of gastric lavage using nasogastric ryle’s tube in pesticide poisoning


Objective: Gastric lavage is mandatory irrespective of nature in all patients with acute poisoning in India. Present study was undertaken with aim whether lavage done using nasogastric Ryle’s tube and small aliquots of water or normal saline is safe. Patients and Methods: All the patients above 12 years of age admitted consecutively with pesticide ingestion or exposure between July 2004 to June 2005 were studied with respect to complications associated with lavage using Ryle’s tube. Forty five patients were admitted directly to our hospital and lavage was undertaken using Ryle’s tube (16F ) with 100 - 200 mL of aliquots till 1 - 1.5 liters of fluid was lavaged, with prophylactic endotracheal intubation in patients with Glasgow coma scale ( GCS) < 10 (group I). The incidence of complications related to lavage in group I was compared to that in 53 patients admitted during same period with pesticide poisoning but lavaged outside using nasogastric Ryle’s tube and referred to our institute (group II). Results: The significant complications observed in group I were significant drop in SaO2 (6 patients) laryngospasm, tachycardia, electrolyte imbalance and tube getting struck in throat (one each). In one patient in group I (had no prophylactic intubation though GCS 3) In group II, 7 had aspiration pneumonia (no prophylactic intubation). Other significant complication was drop in SaO2 during lavage. None of them had any serious life threatening complication. Conclusion: Gastric lavage carried out using nasogastric Ryle’s tube and small aliquots of water or normal saline is relatively safe in patients with pesticide poisoning when combined with prophylactic endotracheal intubation in patients with GCS < 10. In absence of prophylactic intubation, risk of aspiration is there. However aspiration pneumonia is generally mild and not life threatening.

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Bhardwaj, U. , Subramaniyan, A. , Bhalla, A. , Sharma, N. and Singh, S. (2011) Safety of gastric lavage using nasogastric ryle’s tube in pesticide poisoning. Health, 3, 401-405. doi: 10.4236/health.2011.37067.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Dikshit, P.C. (2007) General toxicology. Textbook of forensic medicine and toxicology. PEEPEE Publishers and Distributors (P) Ltd., New Delhi.
[2] Indian Penal Code (1999) Universals criminal manual. Universal Law Publishing Company Private Ltd., New Delhi.
[3] American Academy of Clinical Toxicology and European Association of Poison Centres and Clinical Toxicologists (2004) Position statement: Gastric lavage. Journal of Toxicology - Clinical Toxicology, 42, 933-943. doi:10.1081/CLT-200045006
[4] Henry, J.A. and Hoffman, J.R. (1998) Continuing controversy on gut decontamination. Lancet, 352, 420-421. doi:10.1016/S0140-6736(05)79183-2
[5] Bond, G.R. (2002) The role of activated charcoal and gastric emptying in gastrointestinal decontamination: A state of art review. American Journal of Emergency Medicine, 39, 237-286.
[6] Ardagh, M., Flood, D. and Tait, C. (2001) Limiting the use of gastro-intestinal decontamination does not worsen the outcome from deliberate self poisoning. The New Zealand Medical Journal, 114, 423-425.
[7] Gunnell, D., Ho, D.D. and Murray, V. (2004) Medical management of deliberate drug overdose-a neglected area of suicide prevention. Emergency Medicine Journal, 21, 35-38. doi:10.1136/emj.2003.000935
[8] Eddleston, M., et al. (2007) The hazards of gastric lavage for intentional self poisoning in a resource poor location. Clinical Toxicology, 45, 136-143. doi:10.1080/15563650601006009
[9] Singh, S., Wig, N., Chaudhary, D., Sood, N.K. and Sharma, B.K. (1997) Changing pattern of acute poisoning in adult: Experience of a large Northwest Indian hospital (1970-1989). Journal of Association of Physicians of India, 45, 194-197.
[10] Singh, D., Jit, I. and Tyagi, S. (1999) Changing trends in acute poisoning in Chandigarh zone: A 25 years autopsy experience from a tertiary care hospital in northern India. The American Journal of Forensic Medicine and Pathology, 20, 203-210. doi:10.1097/00000433-199906000-00019
[11] Eddleston, M. (2000) Pattern and problems of deliberate self poisoning in the developing world. The Quart Journal, 93, 715-731.
[12] Eddleston, M., Senarathna, I., Mohmad, F., Buckley, N., Juszczak, E., et al. (2003) Deaths due to absence of an affordable antitoxin for plant poisoning. Lancet, 362, 1041-1044. doi:10.1016/S0140-6736(03)14415-7
[13] Eddleston, M., Singh, S. and Buckley, N. (2007) Acute organophosphorus poisoning. Clinical Evidence Handbook. British Medical Journal Publishing Group, London, 413-415.
[14] Bhattarai, M.D. (2000) Gastric lavage is perhaps more important in developing countries. BMJ, 320, 711. doi:10.1136/bmj.320.7236.711
[15] Fernando, R. (1998) Management of acute poisoning. The National Poisons Information Centre in Sri Lanka, Colombo.

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