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In what poisoning stomach wash is used

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Here is a thorough answer based on authoritative forensic medicine and toxicology textbooks:

Gastric Lavage (Stomach Wash) in Poisoning

Definition & Timing

Gastric lavage is the washing out of the stomach contents through a stomach tube. It is most effective and potentially life-saving when performed within 4 to 6 hours of poison ingestion, though some sources cite 1 hour as the ideal window for maximum benefit.

Indications - When to Use Gastric Lavage

Gastric lavage is used in the following types of poisoning:
Type of PoisoningLavage Fluid Used
Most acute oral poisonings (general)Plain warm water (35°C) or normal saline
Alkaloids (morphine, strychnine, etc.) & SalicylatesPotassium permanganate (1:5000 or 1:10,000)
Acid poisoningSodium bicarbonate (5%)
Carbolic acid / Phenolic group poisonsCastor oil and warm water (1:2 ratio)
Cyanide poisoningSodium thiosulfate (25%)
Oxalate poisoningCalcium gluconate
Iron poisoningDesferrioxamine (2 g in 1 litre of water)
Arsenic poisoningPlain gastric lavage + vasopressors + dimercaprol (BAL)
Lead poisoningDilute magnesium sulphate or sodium sulphate solution
Chromic acid poisoningAlkaline solution (sodium bicarbonate)
After the poison is removed, additional solutions may be left in the stomach:
  • Magnesium sulphate / Sodium sulphate - to purge any poison that passed into the intestine
  • Sodium bicarbonate - for aspirin/salicylate poisoning to counteract gastric irritation and accelerate excretion
  • Activated charcoal - to adsorb alkaloids and other toxins
  • Liquid paraffin - as a demulcent fluid

Procedure (Summary)

  1. Patient placed prone or semiprone with hips higher than the head
  2. Remove dentures; ensure clear airway; use mouth gag
  3. Pass a flexible rubber stomach tube (~12.7 mm diameter, ~1.5 m long, marked at 50 cm) lubricated with liquid paraffin or glycerine
  4. Confirm placement (air bubbling sound over stomach with stethoscope)
  5. First wash with ~250 mL (quarter litre) of plain warm water - siphon off and preserve first sample for chemical analysis
  6. Repeat with 500 mL (half litre) each time using appropriate antidotal fluid until the returning fluid is clear
  7. Pinch the tube before withdrawing to prevent aspiration
  8. In children: use a Ryle's tube or No. 8-12 French rubber catheter (~25 cm length)

Contraindications

Absolute Contraindications

  1. Corrosive poisoning (acids, alkalis) - except carbolic acid - due to risk of oesophageal/gastric perforation
  2. Convulsant poisons (e.g. strychnine - convulsions must be controlled first)
  3. Comatose patients without airway protection (risk of aspiration)
  4. Volatile poisons / petroleum distillates / kerosene - risk of aspiration pneumonitis
  5. Hypothermia - body temperature must be addressed first

Relative Contraindications

  1. Oesophageal varices or other alimentary tract diseases
  2. Advanced pregnancy
  3. Haemorrhagic diathesis (bleeding disorders)
  4. Recent surgical operation of the GI tract
  5. Ingestion of alkali

Complications

  1. Laryngeal spasm
  2. Aspiration pneumonitis
  3. Perforation of the stomach or oesophagus
  4. Sinus bradycardia and ST elevation on ECG
Sources:
  • P C Dikshit Textbook of Forensic Medicine and Toxicology, Procedure for Stomach Wash (pp. 434-435)
  • Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, Removal of Unabsorbed Poison (pp. 559-560)
  • Harrison's Principles of Internal Medicine 22E (2025), Prevention of Poison Absorption

in carbolic acid poison , can we use stomach wash

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Excellent! I now have comprehensive information from both major forensic medicine textbooks. Here is the complete answer:

Gastric Lavage in Carbolic Acid (Phenol) Poisoning

Answer: YES - It is Permitted (Special Exception)

Carbolic acid (phenol) is the one important exception among corrosive poisons where gastric lavage is allowed and recommended. While gastric lavage is absolutely contraindicated in other corrosive poisonings (strong acids, alkalis) due to the risk of perforation, carbolic acid is different for one key reason:
"Since the degree of corrosion is not as severe as mineral acids and the tissues are also hardened by carbolic acid, a soft stomach tube can be passed with care."
  • Parikh's Textbook of Medical Jurisprudence

Why Carbolic Acid is an Exception

FeatureStrong Mineral Acids/AlkalisCarbolic Acid
Degree of corrosionSevere - deep tissue destructionMild - tissues are hardened (coagulated protein)
Risk of perforationVery highRelatively lower
Tube passageDangerousCan be done carefully with a soft tube
Stomach washContraindicatedPermitted and recommended

Gastric Lavage Protocol for Carbolic Acid Poisoning

Fluids used for washing:

  1. Castor oil + warm water (1:2 ratio) - the classic specific fluid (phenol dissolves in oil)
  2. 10% glycerine in water - forms glycerol-phenol complex
  3. Plain warm water + magnesium sulphate - magnesium sulphate forms insoluble sulphocarbolate
  4. Lukewarm water with activated charcoal, olive oil, saccharated lime - phenol combines and forms harmless products
  5. Soap solution or 10% glycerin
  6. Alcohol (10% solution) - prevents the cauterising action of phenol (must be removed shortly afterwards as it does not combine chemically)

Endpoint:

  • Continue washing until the washings no longer emit phenolic odour (or until clear and odourless)

After lavage (leave in stomach):

  • 1 oz (30 g) magnesium sulphate - forms insoluble sulphocarbolate
  • OR 2 oz medicinal liquid paraffin - acts as demulcent

Complete Treatment of Carbolic Acid Poisoning

  1. Emesis - often fails due to the anaesthetic effect of carbolic acid on the stomach
  2. Gastric lavage - as above (thorough, with appropriate fluids)
  3. IV saline + sodium bicarbonate - to render urine alkaline, combat circulatory depression, dilute carbolic acid in blood, and encourage excretion through diuresis
  4. Demulcents - white of egg, milk
  5. Haemodialysis - if renal failure develops
  6. Methylene blue IV - if severe methaemoglobinaemia occurs
  7. Skin/surface burns - wash with water, then apply castor oil; or undiluted polyethylene glycol; or soap and water for 15 minutes

Key Exam Point

The rule as taught in forensic medicine:
"Gastric lavage is contraindicated in corrosive poisoning EXCEPT carbolic acid"
This is because other corrosives (H₂SO₄, HCl, HNO₃, NaOH) cause severe, deep tissue liquefaction/coagulative necrosis that greatly increases the risk of oesophageal or gastric perforation when a tube is passed. Carbolic acid's protein-coagulating (hardening) effect actually limits deep penetration and makes careful tube passage feasible.
Sources:
  • Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, Carbolic Acid (Phenol) - Treatment (p. 580-581)
  • The Essentials of Forensic Medicine and Toxicology, 36th Edition (2026), Carbolic Acid (Phenol) - Treatment (p. 505)
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