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Reactions 435 - 23 Jan 1993 Finding a niche for activated charcoal In a BMJ editorial, JA Vale and AT Proudfoot, respective Directors of the National Poisons Information Service Centres in Birmingham, England and Edinburgh, Scotland, have addressed the role of activated charcoal in the management of poisoning. They comment that one of the main problems in determining the efficacy of activated charcoal is that most studies have been in volunteers, thus the data are of ‘doubtful relevance’ in poisoned patients. In volunteers, activated charcoal has been shown to be better than ipecac and gastric lavage for reducing drug absorption, and this has also been shown in patients poisoned with paracetamol [acetaminophen]. However, there is no evidence that charcoal reduces the need for an antidote. ‘More information is required before gastric lavage can be abandoned completely in favour of giving activated charcoal . . .’, say Vale and Proudfoot. Morbidity and mortality have not been shown to be reduced with repeated doses of oral activated charcoal. Until more specific data are available, Vale and Proudfoot recommend that severely poisoned adults should receive activated charcoal 150-200g via a nasogastric tube over 4-8 hours; the aim should be to maximally reduce the elimination half-life and improve the patient’s clinical condition. They add that ‘the total dose is probably more important than the frequency of dosing’. Vale JA, et al. How useful is activated charcoal? Studies have left many unanswered questions. BMJ 306: 78-79, 9 Jan 1993 800175292 1 Reactions 23 Jan 1993 No. 435 0114-9954/10/0435-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Finding a niche for activated charcoal

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Page 1: Finding a niche for activated charcoal

Reactions 435 - 23 Jan 1993

Finding a niche for activatedcharcoal

In a BMJ editorial, JA Vale and AT Proudfoot,respective Directors of the National Poisons InformationService Centres in Birmingham, England and Edinburgh,Scotland, have addressed the role of activated charcoalin the management of poisoning.

They comment that one of the main problems indetermining the efficacy of activated charcoal is thatmost studies have been in volunteers, thus the data areof ‘doubtful relevance’ in poisoned patients. Involunteers, activated charcoal has been shown to bebetter than ipecac and gastric lavage for reducing drugabsorption, and this has also been shown in patientspoisoned with paracetamol [acetaminophen]. However,there is no evidence that charcoal reduces the need foran antidote.

‘More information is required before gastriclavage can be abandoned completely in favour ofgiving activated charcoal . . .’, say Vale and Proudfoot.

Morbidity and mortality have not been shown to bereduced with repeated doses of oral activated charcoal.Until more specific data are available, Vale andProudfoot recommend that severely poisoned adultsshould receive activated charcoal 150-200g via anasogastric tube over 4-8 hours; the aim should be tomaximally reduce the elimination half-life and improvethe patient’s clinical condition. They add that ‘the totaldose is probably more important than the frequencyof dosing’.Vale JA, et al. How useful is activated charcoal? Studies have left manyunanswered questions. BMJ 306: 78-79, 9 Jan 1993 800175292

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Reactions 23 Jan 1993 No. 4350114-9954/10/0435-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved