Assessment of the Efficacy of Activated Charcoal Following Gastric Lavage in Acute Drug Emergencies

Comstock, Eric G.; Boisaubin, Eugene V.; Comstock, Betsy S.; Faulkner, Thomas P.

doi:10.3109/15563658208990377

Cited by 31 publications

(12 citation statements)

References 16 publications

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“…Fifty-six patients (47%) consumed the entire container of AC, which included 46 15-g containers, 8 25-g containers, and 2 30-g containers. Eight (7%) of 116 children who were treated at home vomited after AC administration.…”

Section: Resultsmentioning

confidence: 99%

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Evaluation of Administration of Activated Charcoal in the Home

Spiller¹,

Rodgers²

2001

Pediatrics

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ABSTRACT. Objective. Activated charcoal (AC) is recognized as the treatment of choice for gastrointestinal decontamination after many ingestions. AC use in the home has been limited by concerns that parents would not administer it properly and that children would refuse to take AC. Previous descriptions of home administration have reported mixed results.Methods. This was an 18-month consecutive case series of all patients for whom AC administration was recommended in the home. Data collected included AC availability in the home and/or a local pharmacy, success in administration, amount administered, time after ingestion to AC administration, difficulties in administration, adverse effects, age and gender of patient, substance involved in poisoning, and medical outcome. All cases were followed for at least 3 days after the ingestion. Patients who initially had home AC recommendation but who ultimately were treated in the emergency department (ED) served as a comparison group.Results. Home administration of AC was recommended in 138 cases. A total of 115 individuals (83%) were treated with AC in the home, with no failures to administer AC. Reasons for failure to manage at home were 1) mother preferred ED (8 cases), 2) could not locate AC (7 cases), 3) pharmacy closed for the night (6 cases) and 4) no home telephone for follow-up (2 cases). Time to AC administration after ingestion was a mean of 38 minutes (؎18.3) for home treatment and 73 minutes (؎18.1) for ED treatment. Ninety-five percent of home cases received AC in <60 minutes versus 33% for ED management. AC was in the home in 11 cases at the time of recommendation. The amount of AC administered was a mean of 12.1 g (standard deviation: 6.9) and a median of 12 g. Eight children (6.9%) who were treated at home vomited after AC versus 3 (13%) who received ED treatment. No aspirations or complications occurred.Conclusion. AC can be administered successfully by the lay public in the home. Home use of AC significantly reduces the time to AC administration. Pediatrics 2001; 108(6). URL: http://www.pediatrics.org/cgi/content/full/ 108/6/e100; activated charcoal, home treatment, children.ABBREVIATIONS. AC, activated charcoal; GI, gastrointestinal; ED, emergency department.A ctivated charcoal (AC) is recognized as the treatment of choice for gastrointestinal (GI) decontamination after many ingestions. 1,2 Recognition of AC's superior efficacy over syrup of ipecac has led to suggestions of administration of AC in the home. [3][4][5] However, use in the home has not gained wide acceptance because of concern that it would not be administered properly by the untrained lay public and that many children would refuse to take AC. This concern has generated considerable speculation but little evidence that AC utility in the home is limited by these problems. Previous descriptions of home administration reported mixed results. 6,7 In 1996, the Kentucky Regional Poison Center began to advise parents of small children to stock AC in the home for use in the event of an unintentio...

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Section: Resultsmentioning

confidence: 99%

“…[3][4][5][7][8][9] Since this work has been done, there has been a continuous 10-year decline in the use of ipecac while at the same time a comparable increase in the use of AC. 10 This has followed a similar decline in the general use of home GI decontamination.…”

Section: Discussionmentioning

confidence: 98%

Evaluation of Administration of Activated Charcoal in the Home

Spiller¹,

Rodgers²

2001

Pediatrics

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“…Activated charcoal, single-dose There were 13 clinical trials (level 1b) that examined the effect of activated charcoal on aspirin absorption (193)(194)(195)(196)(197)(198)(199)(200)(201)(202)(203)(204)(205). None of these studies was performed as out-of-hospital care.…”

Section: Treatment Measuresmentioning

confidence: 99%

“…There was no benefit to the addition of activated charcoal to lavage based on the proportion of patients whose serum salicylate concentrations continued to rise after the intervention. The number of aspirin patients was small and the serum concentrations were low, indicating non-serious poisoning (194). The other 11 clinical studies involved adult volunteers who received non-toxic doses of aspirin prospectively.…”

Section: Treatment Measuresmentioning

confidence: 99%

Salicylate poisoning: An evidence-based consensus guideline for out-of-hospital management

Chyka

Erdman

Christianson

et al. 2007

Clinical Toxicology

113

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of U.S. poison center data for 2004 showed over 40,000 exposures to salicylate-containing products. A guideline that determines the conditions for emergency department referral and pre-hospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected exposure to salicylates by 1) describing the process by which a specialist in poison information should evaluate an exposure to salicylates, 2) identifying the key decision elements in managing cases of salicylate exposure, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses: 1) Patients with stated or suspected self-harm or who are the victims of a potentially malicious administration of a salicylate, should be referred to an emergency department immediately. This referral should be guided by local poison center procedures. In general, this should occur regardless of the dose reported (Grade D).2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion warrants referral to an emergency department for evaluation (Grade C). 3) Patients who exhibit typical symptoms of salicylate toxicity or nonspecific symptoms such as unexplained lethargy, confusion, or dyspnea, which could indicate the development of chronic salicylate toxicity, should be referred to an emergency department (Grade C). 4) Patients without evidence of self-harm should have further evaluation, including determination of the dose, time of ingestion, presence of symptoms, history of other medical conditions, and the presence of co-ingestants. The acute ingestion of more than 150 mg/kg or 6.5 g of aspirin equivalent, whichever is less, war...

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“…One study found that patients who received GL and activated charcoal did no better than those that received activated charcoal alone [8,9]. In fact, patients that received GL had an increased incidence of aspiration pneumonia despite being endotracheally intubated [9].…”

Section: Introductionmentioning

confidence: 99%

The Use of Gastric Lavage in India for Poisoned Patients

Naderi¹

2012

J Clin Toxicol

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Background: According to current international standards, gastric lavage (GL) should not be employed routinely, if ever, in the management of poisoned patients. Several clinical studies have demonstrated that the risks outweigh the benefits of this procedure. The utility of GL decreases as a function of time and is minimally effective more than one hour after toxin ingestion. Nonetheless, observational experience suggests that this procedure is still widely practiced in response to toxic ingestion in India. This study aims to quantify the prevalence and scope of gastric lavage use among healthcare providers in India.

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Assessment of the Efficacy of Activated Charcoal Following Gastric Lavage in Acute Drug Emergencies

Cited by 31 publications

References 16 publications

Evaluation of Administration of Activated Charcoal in the Home

Evaluation of Administration of Activated Charcoal in the Home

Salicylate poisoning: An evidence-based consensus guideline for out-of-hospital management

The Use of Gastric Lavage in India for Poisoned Patients

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