Charcoal stercolith with intestinal perforation in a patient treated for amitriptyline ingestion

Gomez, Hernan F.; Brent, Jeffrey; Munoz, David C.; Mimmack, Robert F.; Ritvo, Jonathan I.; Phillips, Scott; McKinney, Patrick E.

doi:10.1016/0736-4679(94)90013-2

Cited by 36 publications

(20 citation statements)

References 25 publications

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“…In the literature there are case reports of unusual gastrointestinal complications such as esophageal perforation with lavage tube resulting in charcoal mediastinum [45], gastrointestinal perforation with charcoal peritoneum [46], charcoal stercolith with perforation [47], charcoal bezoar from multiple doses of charcoal, causing small bowel obstruction [48], and a manually disimpacted charcoal 'briquette' that caused constipation after a single dose of charcoal [31].…”

Section: Other Complicationsmentioning

confidence: 99%

Activated charcoal for pediatric poisonings: the universal antidote?

Lapus

2007

Current Opinion in Pediatrics

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If used appropriately, activated charcoal has relatively low morbidity. Due to the lack of definitive studies showing a benefit in clinical outcome, it should not be used routinely in ingestions. AC could be considered for patients with an intact airway who present soon after ingestion of a toxic or life-threatening dose of an adsorbable toxin. The appropriate use of activated charcoal should be determined by the analysis of the relative risks and benefits of its use in each specific clinical scenario.

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Section: Other Complicationsmentioning

confidence: 99%

Activated charcoal for pediatric poisonings: the universal antidote?

Lapus

2007

Current Opinion in Pediatrics

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“…Compliance is unpredictable, and complications may occur when passing a nasogastric tube to administer the charcoal. Addition of a cathartic may cause diarrhea and failure to give a laxative may cause constipation or the formation of charcoal briquettes in the intestinal tract [66]. Charcoal has been blamed for appendicitis [67] and intestinal perforation [68] in single case reports.…”

Section: What Are the Risks Of Giving Activated Charcoal?mentioning

confidence: 99%

Activated Charcoal for Acute Poisoning: One Toxicologist’s Journey

Olson

2010

J. Med. Toxicol.

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“…111 Apart from lethargy, she was asymptomatic but was prescribed activated charcoal 50 g every 4 hours; she declined more than 100 g. Four days later after 2 enemas, perforation occurred. 111 Apart from lethargy, she was asymptomatic but was prescribed activated charcoal 50 g every 4 hours; she declined more than 100 g. Four days later after 2 enemas, perforation occurred.…”

Section: Gastrointestinal Complicationsmentioning

confidence: 99%

“…107,108,110,111 • Regurgitation, with subsequent aspiration into the lungs of gastric contents containing charcoal, or direct installation of charcoal into the lungs as a result of a misplaced nasogastric tube, has led rarely to severe pulmonary complications and death. 107,108,110,111 • Regurgitation, with subsequent aspiration into the lungs of gastric contents containing charcoal, or direct installation of charcoal into the lungs as a result of a misplaced nasogastric tube, has led rarely to severe pulmonary complications and death.…”

Section: Complications Of Usementioning

confidence: 99%

Position Statement and Practice Guidelines on the Use of Multi-Dose Activated Charcoal in the Treatment of Acute Poisoning

Toxicologists¹

1999

Journal of Toxicology: Clinical Toxicology

296

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In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. 1-124 Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the Boards of the two societies.The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Although many studies in animals and volunteers have demonstrated that multiple-dose activated charcoal increases drug elimination significantly, this therapyhas not yet been shown in a controlled study in poisoned patients to reduce morbidity and mortality. Further studies are required to establish its role and the optimal dosage regimen of charcoal to be administered. Based on experimental and clinical studies, multiple-dose activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline. With all This Position Statement is endorsed by the Canadian Association of Poison Control Centres. 731 Clinical Toxicology Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15For personal use only. ORDER REPRINTS 732AACT and EAPCCT of these drugs there are data to confirm enhanced elimination, though no controlled studies have demonstrated clinical benefit.Although volunteer studies have demonstrated that multiple-dose activated charcoal increases the elimination of amitriptyline, dextropropoxyphene, digitoxin, digoxin, disopyramide, nadolol, phenylbutazone, phenytoin, piroxicam, and sotalol, there are insufficient clinical data to support or exclude the use of this therapy.The use of multiple-dose charcoal in salicylate poisoning is controversial. One animal study and 2 of 4 volunteer studies did not demonstrate increased salicylate clearance with multiple-dose charcoal therapy. Data in poisoned patients are insufficient presently to recommend the use of multiple-dose charcoal therapy for salicylate poisoning.Multiple-dose activated charcoal did not increase the elimination of astemizole, chlorpropamide, doxepin, imipramine, meprobamate, methotrexate, phenytoin, sodium valproate, tobramycin, and vancomycin in experimental and/or clinical studies.Unless a patient has an intact or protected airway, the administration of multiple-dose activated charcoal is contraindicated. It should not be used in the presence of an intestinal obstruction. The need for concurrent administration of cathartics remains unproven and is not recommended. In particular, cathartics shoul...

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Charcoal stercolith with intestinal perforation in a patient treated for amitriptyline ingestion

Cited by 36 publications

References 25 publications

Activated charcoal for pediatric poisonings: the universal antidote?

Activated charcoal for pediatric poisonings: the universal antidote?

Activated Charcoal for Acute Poisoning: One Toxicologist’s Journey

Position Statement and Practice Guidelines on the Use of Multi-Dose Activated Charcoal in the Treatment of Acute Poisoning

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