Multiple-dose activated charcoal in an accidental vancomycin overdose.
BACKGROUND
Multiple-dose activated charcoal may enhance the enterocapillary clearance of vancomycin.


METHODS
A 17-day-old female neonate born with congenital meningomyelocele and Arnold-Chiari malformation was iatrogenically overdosed with a 500 mg intravenous bolus of vancomycin during a shunt operation. The Red Man's Syndrome developed within minutes, characterized by sudden hypotension, skin rash and cyanosis. Serum vancomycin level at one hour after the injection was 165.7 micrograms/mL, as measured by an enzyme immunoassay method (EMIT). Multiple dose activated charcoal, 1 g/kg, was first given five hours after injection, and continued every four hours for 12 doses. The half-life of vancomycin during charcoal administration was calculated to be 9.4 h or less than the reported 13.4-33.7 h half-life in normal neonates. The neonate's renal function tests and brainstem auditory responses remained normal.


CONCLUSIONS
Gastrointestinal dialysis with multiple-dose activated charcoal without cathartics appeared to shorten the elimination half-life of vancomycin.
Kucukguclu
S
S
Dokuz Eylul University Hospital, Inciralti, Izmir, Turkey.
Tuncok
Y
Y
Ozkan
H
H
Guven
H
H
Uguz
A
A
Maltepe
F
F
D000900:Anti-Bacterial Agents / Q000506:poisoning*; D002606:Charcoal / Q000008:administration & dosage*; D003490:Cyanosis / Q000517:prevention & control*; D003875:Drug Eruptions / Q000517:prevention & control*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007022:Hypotension / Q000517:prevention & control*; D007231:Infant, Newborn; D013577:Syndrome; D014640:Vancomycin / Q000506:poisoning*
D000900:Anti-Bacterial Agents; D002606:Charcoal; D014640:Vancomycin