GI Decontamination The effort to “get the poison out” has long been a mainstay of the traditional discussion of toxicologic management However, gastric emptying measures have fallen out of favor, and the routine use of activated charcoal as a poison adsorbent has likewise been subjected to increased academic scrutiny Unfortunately, young children have been underrepresented in clinical studies of GI decontamination It is likely that as further research is conducted, particularly as directed toward the pediatric population, current dogma regarding optimal GI decontamination will evolve For the sections that follow, we review several appropriate techniques for gastric decontamination, all of which may be useful under certain circumstances We then offer an approach to the overall decision process for specific patients Gastric Emptying The goal of gastric emptying is to rid the stomach of remaining poison to prevent further systemic absorption The utility of gastric emptying diminishes with time and is most effective if done early after ingestion when unabsorbed drug is still present within the stomach (operationally, within the first 30 minutes to hour) In certain circumstances, such as the delayed gastric emptying accompanying intoxication with anticholinergic drugs or the presence of iron tablets in the stomach, benefit may be noted longer after ingestion Induced emesis (with syrup of ipecac) was once a favored means of gastric emptying, but the American Academy of Pediatrics no longer recommends that syrup of ipecac be used routinely for the poisoned patient in the home or healthcare facility This was in response to inconsistent data regarding decreased drug absorption, no evidence that it changes clinical outcomes, potential for abuse in vulnerable patients, and the concern that it may delay time to administration of other more effective therapies An alternative to ipecac-induced emesis for emptying the stomach is gastric lavage This procedure has very limited indications and is usually reserved for patients who have ingested a potentially life-threatening amount of poison, in cases where the procedure can be performed safely very early after ingestion and charcoal alone is not adequate To carry out a satisfactory lavage, the patient should be on his or her left side, head slightly lower than feet, and the largest orogastric lavage tube that can reasonably be passed should be used (e.g., 24F orogastric tube for a toddler, 36F orogastric tube for an adolescent) A smaller caliber nasogastric (NG) tube is sufficient for some liquid toxins, but liquid toxins are generally rapidly absorbed Gastric contents should be aspirated initially before any lavage fluid is introduced Normal saline aliquots of 50 to 100 mL in young children and 150 to 200 mL in adolescents can be lavaged repeatedly until