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

Abstract

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...

Clinical and sociodemographic profile of acute intoxications in an emergency department: A retrospective cross-sectional study

“…The number of digestive decontaminations performed in this study was high compared to the records published annually by the American Association of Poison Control Centers (AAPCC) ( 27 ). Many studies have revealed that the combination of LG and CA is not more effective than the exclusive administration of CA ( 28 , 29 ). However, in Alcañiz, this association occurred 1 out of 3 times.…”

Physical Examination and Clinical Course of Poisoning and Drug Overdose

“…carbamazepine, or theophylline. Urinary alkalinization can enhance the elimination of salicylates and a few other poisons [16][17][18]. Chelation therapy can also enhance the elimination of selected metals.…”

“…This is a therapeutic inotropic agent/antiarrhythmic with a narrow therapeutic window. It presents with nausea, malaise, weakness, bradycardia, heart block, hyperkalemia, visual complaints of seeing yellow halos around lights[17]. Treatment with digoxin-specific antibody is indicated for hemodynamically compromising conduction disturbances or for hyperkalemia.…”

Clinical Toxicology and Overdose of Psychiatric Medications

“…For dermal contact, surface decontamination with copious amount of water is most effective. For poison ingestion, methods of gastrointestinal (GI) decontamination include gastric lavage, 4 single-dose activated charcoal, 5 multipledose activated charcoal, 6 whole bowel irrigation, 7 and rarely surgical intervention such as endoscopic removal or gastrostomy. In Hong Kong, about 15% of poisoning cases are treated with GI decontamination mostly by oral administration of activated charcoal.…”