Treatment of the poisoned child.

Sir, There may well be a place for emetics in the treatment of children who have ingested poison, as advocated by David Reid (1970). However, on the evidence at present available, it is quite unjustifiable to conclude that emesis is superior to gastric lavage in terms of safety or effectiveness. The risks of properly performed lavage are frequently exaggerated. Bleeding does occur in approximately half ofthose washed out, but this has never, in my experience, required treatment. Reid states that cardiac arrest has been reported as a complication of lavage by Lee and Ames (1965). In fact, these authors merely suggest lavage might cause arrest but presented no evidence to support this. Serious complications of lavage are rare (Matthew et al., 1966; Burke, 1968). In the individual case neither emesis nor lavage can be relied upon to empty the stomach. Corby et al. (1968) gave children a known quantity of magnesium hydroxide before inducing emesis using ipecac and apomorphine. The average recovery of stomach contents with ipecac was 28% and apomorphine 31 -3%. They concluded that neither drug was highly efficient in emptying the stomach. During the past four years I have been carrying out similar studies in a group of 362 adults using gastric lavage. The average return of magnesium sulphate was 63 *5%. During the course of this study it was realized that the position of the patient influenced the efficiency of the procedure. With the patient in a modified left-sided Simm's position, and the table tilted head down, it is possible to obtain average returns of 84% magnesium sulphate. No attention appears to have been paid to the technique of lavage when comparing it with emesis in the studies that Reid referred to. It is therefore doubtful whether any valid conclusions can be drawn from such work. There are two situations where I feel emetics would be valuable. The first is in conscious, co-operative patients (apart from those who have taken paraffin) immediately the ambulance reaches them. The second is in children who have taken seeds, berries, or enteric-coated tablets, for these are unlikely to be recovered by lavage. At the moment, emesis should be considered as an additional aid to emptying the stomach, but should not replace lavage. Finally, there are good reasons for preferring copper sulphate solution to ipecac as an emetic (Karlson and Noren, 1965). MICHAEL BuRKE Royal Victoria Infirmary, Newcastle upon Tyne NEI 4LP.