Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial.
BACKGROUND
The case-fatality for intentional self-poisoning in the rural developing world is 10-50-fold higher than that in industrialised countries, mostly because of the use of highly toxic pesticides and plants. We therefore aimed to assess whether routine treatment with multiple-dose activated charcoal, to interrupt enterovascular or enterohepatic circulations, offers benefit compared with no charcoal in such an environment.


METHODS
We did an open-label, parallel group, randomised, controlled trial of six 50 g doses of activated charcoal at 4-h intervals versus no charcoal versus one 50 g dose of activated charcoal in three Sri Lankan hospitals. 4632 patients were randomised to receive no charcoal (n=1554), one dose of charcoal (n=1545), or six doses of charcoal (n=1533); outcomes were available for 4629 patients. 2338 (51%) individuals had ingested pesticides, whereas 1647 (36%) had ingested yellow oleander (Thevetia peruviana) seeds. Mortality was the primary outcome measure. Analysis was by intention to treat. The trial is registered with controlled-trials.com as ISRCTN02920054.


RESULTS
Mortality did not differ between the groups. 97 (6.3%) of 1531 participants in the multiple-dose group died, compared with 105 (6.8%) of 1554 in the no charcoal group (adjusted odds ratio 0.96, 95% CI 0.70-1.33). No differences were noted for patients who took particular poisons, were severely ill on admission, or who presented early.


CONCLUSIONS
We cannot recommend the routine use of multiple-dose activated charcoal in rural Asia Pacific; although further studies of early charcoal administration might be useful, effective affordable treatments are urgently needed.
Eddleston
Michael
M
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. eddlestonm@yahoo.com
Juszczak
Edmund
E
Buckley
Nick A
NA
Senarathna
Lalith
L
Mohamed
Fahim
F
Dissanayake
Wasantha
W
Hittarage
Ariyasena
A
Azher
Shifa
S
Jeganathan
K
K
Jayamanne
Shaluka
S
Sheriff
Mh Rezvi
MR
Warrell
David A
DA
D000328:Adult; D000931:Antidotes / Q000008:administration & dosage*; D002606:Charcoal / Q000008:administration & dosage*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D062025:Organophosphate Poisoning; D010575:Pesticides / Q000506:poisoning; D011041:Poisoning / Q000145:classification / Q000188:drug therapy* / Q000401:mortality; D012424:Rural Population; D013188:Sri Lanka; D013406:Suicide, Attempted; D031052:Thevetia / Q000506:poisoning; D017211:Treatment Failure
D000931:Antidotes; D010575:Pesticides; D002606:Charcoal