Single-Dose Oral Activated Charcoal in the Treatment of the Self-Poisoned Patient: A Prospective, Randomized, Controlled Trial

Abstract

Oral activated charcoal (OAC) is a universally accepted treatment of the overdose patient. Although the benefits of OAC have been suggested, there are no conclusive clinical data indicating that OAC affects outcome in overdose patients. This study was a prospective, randomized, controlled trial to determine the effects of OAC treatment in the self-poisoned adult patient. Adult patients presenting to the emergency department (ED) with a history of oral overdose were assigned to treatment with OAC (50 g) or supportive care only on an even-odd day protocol. Patients did not undergo gastric evacuation procedures in the ED. The outcome measures were clinical deterioration, length of stay in the ED or hospital, and complication rate. Over a 24-month period, 1479 patients were entered into the study. There were no significant differences in outcome parameters between the OAC treatment group and controls when comparing the length of intubation time, length of hospital stay, and the complication rates associated with the overdose. There was a higher incidence of vomiting and longer length of ED stay associated with OAC treatment. The results of this study indicated that oral drug overdose patients do not require gastric evacuation or charcoal administration. OAC provided no additional benefit to supportive care alone, was associated with a higher incidence of vomiting and a longer length of ED stay, and did not improve clinical outcome.

Activated charcoal for pediatric poisonings: the universal antidote?

“…This incidence of vomiting was identical to the no activated charcoal arm of the previously mentioned randomized control trial by Merigian et al [19].…”

“…Many would not hesitate to administer activated charcoal to a comatose patient who presents within 1 h to the emergency department (ED) and has a protected airway; however, the debate seems to focus on the alert and awake patient, with stable vital signs. In a prospective, randomized, controlled study, Merigian et al [19] compared clinical outcome in 1479 self-poisoned patients receiving activated charcoal and supportive care or supportive care alone. They compared the incidence of vomiting, length of stay, and incidence of complications associated with the overdose or the treatment between the two groups.…”

Use of Single-dose Activated Charcoal Among Canadian Pediatric Emergency Physicians

“…Recent adult studies comparing these 2 therapies, excluding clearly toxic ingestions, revealed no difference in outcome in those patients who were treated with supportive care and observation alone. 22,23 A retrospective study of children presenting with poisoning during 3 periods during which there was a decreasing use of gastric decontamination with SDAC also revealed no difference in their outcomes. 21 Given the existing practice variation, 4 -7 the evidence in adults supporting observation alone in all but the most toxic ingestions, and the possible increased risk of SDAC therapy in the pediatric patient, this study highlights the need for a prospective trial of SDAC versus observation alone in a pediatric population, excluding those with toxic acute ingestions.…”

Prehospital activated charcoal: the way forward

“…6 Patients who had taken an acute drug overdose were treated with SDAC on even days of the month and supportive treatment alone on odd days. Patients who had ingested a potentially toxic dose of paracetamol (.140 mg/kg) were excluded (paracetamol accounts for 50% of self poisonings in the UK).…”