Gastric lavage for pills should be done with a 40Fr orogastric tube. An 18Fr nasogastric tube will usually clog with pill fragments or will fail to remove them. The 40Fr tube is often hard to tollerate and the patient may need to be intubated first in order for proper sedation and airway control. After inserting the tube, it is placed to suction. This is followed by instillation of 250cc of NS and resuctioning. This may need to be repeated 2 - 3 times.

After lavage give charcoal. Charcoal is started with an initial dose of 50gm. This can be repeated if needed. Ten grams of charcoal will ususally bind one gram of drug, so give the appropriate dose. Charcoal also works to pull drug from the blood stre am through the intestinal mucosa. This is similar to hemoperfusion and will only clear drugs that are cleared by hemoperfusion.