Efficacy of activated charcoal administered more than four hours after acetaminophen overdose.
To evaluate whether administration of activated charcoal, in addition to standard N-acetylcysteine (NAC) therapy, after acetaminophen overdose provides additional patient benefit over NAC therapy alone, a 1-year non-randomized prospective, multi-center, observational case series was performed at three poison centers and one poison center system. Entrance criteria were all acute acetaminophen overdoses with: 1) an acetaminophen blood concentration determined to be in the toxic range by the Rumack-Matthew nomogram; and 2) all therapies, including NAC and activated charcoal, initiated between 4 and 16 h post-ingestion. There were 145 patients meeting entrance criteria, of whom 58 patients (40%) received NAC only and 87 patients (60%) received NAC and activated charcoal. Overall, 23 patients had elevations of AST or ALT greater than 1000 IU/L, of which 21 patients received NAC only (38% of total NAC only group) and 2 patients received NAC and activated charcoal (2% of total NAC+AC group). Administration of activated charcoal in this series of patients with toxic acetaminophen concentrations treated with NAC was associated with reduced incidence of liver injury, as measured by elevated serum transaminases and prothrombin times.
Spiller
Henry A
HA
Kentucky Regional Poison Center, Louisville, Kentucky 40232-5070, USA.
Winter
Mark L
ML
Klein-Schwartz
Wendy
W
Bangh
Stacey A
SA
D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage; D000293:Adolescent; D000328:Adult; D000368:Aged; D002606:Charcoal / Q000008:administration & dosage*; D002648:Child; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011039:Poison Control Centers; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States
D002606:Charcoal; D000082:Acetaminophen; D000111:Acetylcysteine