A randomized clinical trial of activated charcoal for the routine management of oral drug overdose.
BACKGROUND
Activated charcoal (AC) is commonly used for the routine management of oral drug overdose.


OBJECTIVE
To determine whether the routine use of activated charcoal has an effect on patient outcomes.


METHODS
Randomized controlled unblinded trial.


METHODS
We recruited all adult patients presenting with an oral overdose at The Canberra Hospital, excluding only transfers, late presenters, those who had ingested drugs not adsorbed by activated charcoal or where administration was contraindicated, and very serious ingestions (at the discretion of the admitting physician). Patients were randomized to either activated charcoal or no decontamination.


RESULTS
The trial recruited 327 patients over 16 months. Of 411 presentations, four refused consent, 27 were protocol violations and 53 were excluded from the trial. Only seven were excluded due to the severity of their ingestion. The most common substances ingested were benzodiazepines, paracetamol and selective serotonin reuptake inhibitor antidepressants. More than 80% of patients presented within 4 h following ingestion. There were no differences between AC and no decontamination in terms of length of stay (AC 6.75 h, IQR 4-14 vs. controls 5.5 h, IQR 3-12; p=0.11) or secondary outcomes including vomiting, mortality and intensive care admission.


CONCLUSIONS
Routine administration of charcoal following oral overdose did not significantly influence length of stay or other patient outcomes following oral drug overdose. There were few adverse events. This does not exclude a role in patients who present shortly after ingestion of highly lethal drugs.
Cooper
G M
GM
Pharmacy, University of Canberra, Bruce, ACT 2601, Australia. gabrielle.cooper@canberra.edu.au
Le Couteur
D G
DG
Richardson
D
D
Buckley
N A
NA
D000082:Acetaminophen / Q000506:poisoning*; D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D001569:Benzodiazepines / Q000506:poisoning*; D002606:Charcoal / Q000627:therapeutic use*; D062787:Drug Overdose / Q000150:complications / Q000628:therapy; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007902:Length of Stay; D008297:Male; D017367:Selective Serotonin Reuptake Inhibitors / Q000506:poisoning*
D000082:Acetaminophen; D018712:Analgesics, Non-Narcotic; D001569:Benzodiazepines; D002606:Charcoal; D017367:Selective Serotonin Reuptake Inhibitors