Outcome of Patients with Cholinergic Insecticide Poisoning Treated with Gastric Lavage: A Prospective Observational Cohort Study

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Background: Gastric lavage (GL) is one of the most commonly used decontamination method for cholinergic insecticide ingestion in developing countries despite lack of supporting evidence. This study was designed to evaluate the outcome of patients with cholinergic insecticide poisoning treated with GL in regards to timing and frequency of the procedure. Methods: In this prospective observational cohort study, GL was planned to be administered to patients with cholinergic insecticide poisoning after initial stabilization irrespective of lavage given in peripheral hospitals. Therefore, some patients received one procedure (single GL) and some received more than one procedure (multiple GL). Early GL was defined as GL given within one hour of poison exposure and late GL was referred to performing the procedure after one hour. Results: During the study period, 238 patients with cholinergic insecticide poisoning received GL comprising of 93 who received early, 145 who received late, 127 who received single and 111 who received multiple GL. Seventy-six GL treated patients (31.9%) died. Mortality, early RF and duration of assisted ventilation were not significantly different between patients receiving early and late, or single and multiple GL. Patients receiving multiple GL compared to those who received single GL developed late RF (9.0% vs. 20.5%, P = 0.01) and IMS (9.9% vs. 23.6%, P = 0.005) in significantly lesser extents. In multiple logistic regression analysis, effect of multiple GL on IMS and late RF remained significant (P = 0.04). Conclusion: Number or timing of GL does not show any association with mortality while multiple GL had protective effect against development of late RF and IMS. Hence, GL might be beneficial in cholinergic insecticide poisoning.