title: The frequency of complications associated with the use of multiple-dose activated charcoal.
abstract: OBJECTIVE
  The objective of this study was to determine the frequency of complications associated with the use of multiple-dose activated charcoal.
  
  
  METHODS
  The study population was drawn from 8 tertiary care hospitals in 4 North American cities. Medical records of all inpatients between March 1993 and March 1998 with a discharge diagnosis of poisoning (International Classification of Diseases, 9th edition, Clinical Modification codes 960-989.9) were reviewed to select patients who had received multiple-dose activated charcoal (defined as > or =2 doses administered within 12 hours). Medical records of patients who received multiple-dose activated charcoal were reviewed for patient demographics and clinical information regarding the occurrence of pulmonary aspiration, gastrointestinal obstruction, hypernatremia, hypermagnesemia, corneal abrasion, and other complications associated with the use of multiple-dose activated charcoal.
  
  
  RESULTS
  We reviewed 6,258 medical records, identifying 878 patients who received multiple-dose activated charcoal. We judged 5 (0.6%; 95% confidence interval [CI] 0.1% to 1.1%) patients to have had clinically significant pulmonary aspiration and none (0%; upper 95% CI 0.3%) to have had gastrointestinal obstruction. None of the patients with pulmonary aspiration died or had residual sequelae recorded. Hypernatremia (peak serum sodium >145 mEq/L [145 mmol/L]) was documented in 53 (6.0%; 95% CI 4.4% to 7.6%) patients, of whom 5 (0.6%; 95% CI 0.1% to 1.1%) had a serum sodium concentration of greater than 155 mEq/L (155 mmol/L). Hypermagnesemia (peak serum magnesium >2.5 mg/dL [1.0 mmol/L]) was documented in 27 (3.1%; 95% CI 2.0% to 4.2%) patients, of whom 3 (0.3%; 95% CI 0.1% to 1.0%) had peak values that were greater than 3.75 mg/dL (1.5 mmol/L). One patient had a corneal abrasion (0.1%; 95% CI 0% to 0.6%). No other complications were identified.
  
  
  CONCLUSIONS
  Clinically significant complications associated with the use of multiple-dose activated charcoal occur infrequently.
authors.affiliation: Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Dorrington
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Rollin
authors.initials: R
authors.lastname: Brant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002606:Charcoal / Q000008:administration & dosage* / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D065306:Corneal Injuries; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology; D008274:Magnesium / Q000097:blood; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011015:Pneumonia, Aspiration / Q000453:epidemiology* / Q000209:etiology; D011041:Poisoning / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D002606:Charcoal; D008274:Magnesium