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.
Keller
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Department of Emergency Medicine, Geisinger Medical Center, Danville, Pennsylvania 17822.
Schwab
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Krenzelok
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EP
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