title: Multiple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial.
abstract: BACKGROUND
  Deliberate self-poisoning with yellow oleander seeds is common in Sri Lanka and is associated with severe cardiac toxicity and a mortality rate of about 10%. Specialised treatment with antidigoxin Fab fragments and temporary cardiac pacing is expensive and not widely available. Multiple-dose activated charcoal binds cardiac glycosides in the gut lumen and promotes their elimination. We aimed to assess the efficacy of multiple-dose activated charcoal in the treatment of patients with yellow-oleander poisoning.
  
  
  METHODS
  On admission, participants received one dose of activated charcoal and were then randomly assigned either 50 g of activated charcoal every 6 h for 3 days or sterile water as placebo. A standard treatment protocol was used in all patients. We monitored cardiac rhythm and did 12-lead electocardiographs as needed. Death was the primary endpoint, and secondary endpoints were life-threatening cardiac arrhythmias, dose of atropine used, need for cardiac pacing, admission to intensive care, and number of days in hospital. Analysis was by intention to treat.
  
  
  RESULTS
  201 patients received multiple-dose activated charcoal and 200 placebo. There were fewer deaths in the treatment group (five [2.5%] vs 16 [8%]; percentage difference 5.5%; 95% CI 0.6-10.3; p=0.025), and we noted difference in favour of the treatment group for all secondary endpoints, apart from number of days in hospital. The drug was safe and well tolerated.
  
  
  CONCLUSIONS
  Multiple-dose activated charcoal is effective in reducing deaths and life-threatening cardiac arrhythmias after yellow oleander poisoning and should be considered in all patients. Use of activated charcoal could reduce the cost of treatment.
authors.affiliation: Faculty of Medicine, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. asita@mfac.kln.ac.lk
authors.forename: H A
authors.initials: HA
authors.lastname: de Silva
authors.forename: M M D
authors.initials: MM
authors.lastname: Fonseka
authors.forename: A
authors.initials: A
authors.lastname: Pathmeswaran
authors.forename: D G S
authors.initials: DG
authors.lastname: Alahakone
authors.forename: G A
authors.initials: GA
authors.lastname: Ratnatilake
authors.forename: S B
authors.initials: SB
authors.lastname: Gunatilake
authors.forename: C D
authors.initials: CD
authors.lastname: Ranasinha
authors.forename: D G
authors.initials: DG
authors.lastname: Lalloo
authors.forename: J K
authors.initials: JK
authors.lastname: Aronson
authors.forename: H J
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002606:Charcoal / Q000008:administration & dosage*; D002648:Child; D006801:Humans; D008875:Middle Aged; D011041:Poisoning / Q000188:drug therapy / Q000401:mortality; D016037:Single-Blind Method; D013188:Sri Lanka; D031052:Thevetia / Q000506:poisoning*
chemical_list: D002606:Charcoal