Table 3.

Examples of discrepancies between Summary of Product Characteristics (SPC) documents and TOXBASE in specific categories of gut decontamination

Induced vomiting	TOXBASE: Syrup of ipecac should not be administered routinely in the management of poisoned patients.
	SPC recommendations in contrast to TOXBASE:
	‘vomiting should be induced if the patient is conscious’
	‘it is advisable to stimulate vomiting’
	‘stomach should be emptied by … induction of emesis’
	‘vomiting should be induced with syrup of ipecac’
Gastric lavage	TOXBASE: ‘Gastric lavage should not be employed routinely, if ever, in the management of poisoned patients’. Consider if <1 h after ingestion of life-threatening quantities of specific agents, e.g. lithium, ethylene glycol.
	SPC recommendations in contrast to TOXBASE:
	‘advisable to perform gastric lavage’
	‘gastric lavage should be considered if co-ingestants are suspected’
	‘gastric lavage is useful if performed soon after ingestion’
	‘0.02% solution of potassium permanganate may be used for lavage’
	‘stomach should be emptied immediately by lavage’
	‘gastric lavage … within the first 6 h after ingestion’
Activated charcoal	TOXBASE: ‘Consider administration of activated charcoal if more than (stated dose) has been ingested within 1 h’. Generally recommended with specific exceptions: alcohols, iron, and lithium
	SPC recommendations in contrast to TOXBASE:
	Oral activated charcoal not mentioned
	‘has been shown to not significantly absorb … in an in vitro study’
Other measures	TOXBASE: For a small number of specific agents, additional gut decontamination procedures are recommended, e.g. whole bowel irrigation after lithium ingestion. The routine use of purgatives is not recommended
	SPC recommendations in contrast to TOXBASE:
	‘an osmotic laxative is also recommended’
	‘sorbitol may be as or more effective than emesis’
	‘a saline purge should be given’
	‘charcoal should be followed by magnesium sulphate 15%’ ‘saline cathartic may be used’ ‘a high enema is recommended’