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

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

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.

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.

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.

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.