Contribution of sorbitol combined with activated charcoal in prevention of salicylate absorption.
The use of cathartics and activated charcoal in treating toxic ingestions has become a standard treatment modality. Sorbitol has been shown to be the most rapidly acting cathartic, but its therapeutic significance has been debated. Using a previously described aspirin overdose model, ten healthy volunteers participated in a crossover design study that investigated the effect of activated charcoal alone versus that of activated charcoal and sorbitol in preventing salicylate absorption. In phase 1 of the study, subjects consumed 2.5 g aspirin followed by 25 g activated charcoal one hour later. Urine was collected for 48 hours and analyzed for quantitative salicylate metabolites. Phase 2 was identical except that 1.5 g/kg sorbitol was consumed with the activated charcoal. The mean amount of aspirin absorbed without the use of sorbitol was 1.26 +/- 0.15 g, whereas the mean absorption was 0.912 +/- 0.18 g with the addition of sorbitol. This is a 28% decrease in absorption of salicylates attributable to the use of sorbitol. The difference is significant at P less than .05 by the paired Student's t test. This study demonstrates that the addition of sorbitol significantly decreases drug absorption in a simulated drug overdose model. Effects on absorption in actual overdose situations and on patient outcome should be the subjects of further study.
Department of Emergency Medicine, Geisinger Medical Center, Danville, Pennsylvania 17822.
R E
RE
Keller
R A
RA
Schwab
E P
EP
Krenzelok
D000328:Adult; D001241:Aspirin / Q000493:pharmacokinetics / Q000506:poisoning* / Q000652:urine; D001682:Biological Availability; D002606:Charcoal / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination / Q000592:standards; D005260:Female; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D008297:Male; D013012:Sorbitol / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
D002606:Charcoal; D013012:Sorbitol; D001241:Aspirin