Please use this identifier to cite or link to this item: http://repository.kln.ac.lk/handle/123456789/11464
Title: Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial
Authors: Eddleston, M.
Juszczak, E.
Buckley, N.A.
Senarathna, L.
Mohamed, F.
Dissanayake, W.
Hittarage, A.
Azher, S.
Jeganathan, K.
Jayamanne, S.
Sheriff, M.R.
Warrell, D.A.
Ox-Col Poisoning Study collaborators
Keywords: self-poisoning
Issue Date: 2008
Publisher: Lancet Publishing Group
Citation: Lancet.2008;371(9612):579-87
Abstract: 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. FINDINGS: Mortality did not differ between the groups. 97 (6.3%) of 1531 participants in the multiple-dosegroup 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. INTERPRETATION: 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. Comment in : Is this the epitaph for multiple-dose activated charcoal? [Lancet. 2008]
URI: http://repository.kln.ac.lk/handle/123456789/11464
ISSN: 0140-6736 (Print)
1474-547X (Electronic)
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