Gastrointestinal decontamination for enteric-coated aspirin overdose: what to do depends on who you ask

J Toxicol Clin Toxicol. 2000;38(5):465-70. doi: 10.1081/clt-100102004.

Abstract

Context: Overdoses with enteric-coated preparation are common. The optimal means by which to limit drug absorption in such cases is controversial.

Objective: To describe the recommendations for gastrointestinal decontamination issued by North American poison control centers for a hypothetical patient, (an adult male with normal vital signs), presenting 1 hour after ingesting 500 mg/kg of enteric-coated aspirin.

Design: Telephone survey of 76 poison control centers in North America. Seven toxicologists who contributed to the American Academy of Clinical Toxicology/European Association of Poison Centres and Clinical Toxicologists position statements on gastrointestinal decontamination were also surveyed for informal comparison.

Results: Most poison control centers (99%) and all of the toxicologists (100%) participated in the survey. Four centers (5 %) recommended syrup of ipecac and 38 (51%) recommended gastric lavage, compared with 0% and 0% of toxicologists, respectively. Seventy-three centers (97%) recommended at least one dose of activated charcoal, compared with 6 toxicologists (86%). Twenty-one poison centers (28%) recommended whole-bowel irrigation, compared with 3 toxicologists (43%). A total of 36 different courses of action were suggested by respondents at the poison centers. Some of these recommendations were potentially harmful.

Conclusions: Considerable variability exists in the recommendations of North American poison control centers for the gastrointestinal decontamination of patients with large, acute overdoses of enteric-coated aspirin.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / poisoning*
  • Aspirin / pharmacokinetics
  • Aspirin / poisoning*
  • Charcoal / therapeutic use
  • Decontamination / methods*
  • Digestive System / metabolism
  • Drug Overdose
  • Emetics / therapeutic use
  • Enterosorption / methods
  • Gastric Lavage
  • Health Care Surveys
  • Humans
  • Intestinal Absorption / drug effects
  • Ipecac / therapeutic use
  • Male
  • Poison Control Centers
  • Tablets, Enteric-Coated

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Emetics
  • Tablets, Enteric-Coated
  • Charcoal
  • Ipecac
  • Aspirin