the return is clear Like induced emesis, gastric lavage’s efficacy in reducing drug absorption has been reviewed critically; the efficacy has been highly variable and lavage has not demonstrated improved outcomes in poisoned patients Several important risks are associated with gastric lavage, including oxygen desaturation, aspiration, and mechanical trauma to the oropharynx and esophagus Gastric lavage is thus rarely recommended but might be considered for patients presenting very early after very dangerous ingestions (of toxicants such as colchicine or arsenic) Contraindications to the procedure include caustic or corrosive ingestions, impending loss of airway protection, and the presence of cardiac arrhythmia Activated Charcoal Activated charcoal minimizes absorption of drugs by adsorbing them onto its large surface area Charcoal administration has become the decontamination strategy of choice to prevent pediatric poisoning after toxicant ingestion and is most effective when used in the first hour after ingestion Therefore, if activated charcoal is considered as a treatment option, quick triage of an exposed patient may be necessary to allow charcoal administration in a timely fashion A number of important compounds, such as iron and lithium, not adsorb well to activated charcoal ( Table 102.9 ) The usual dose of activated charcoal is g/kg; adolescents and adults should receive 50 to 100 g Most activated charcoal is now available premixed with water to make slurry that can be taken orally or administered by NG tube Simply adding soda or another nonparticulate flavoring agent to the charcoal can improve palatability TABLE 102.9 SUBSTANCES POORLY (OR NOT) ADSORBED BY ACTIVATED CHARCOAL Common electrolytes Metals—iron, lead, arsenic, lithium Mineral acids or bases Alcohols Cyanide Most solvents Most water-insoluble compounds (e.g., hydrocarbons)