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Title: | Multiple-dose activated charcoal for treatment of yellow oleander poisoning : a single-blind randomized placebo controlled trial |
Authors: | de Silva, H.A. Fonseka, M.M.D. Pathmeswaran, A. Alahakoon, D.G.S. Ratnatilaka, G.A. Gunatilake, S.B. Ranasinha, C.D. Lalloo, D.G. Aronson, J.K. de Silva, H.J. |
Keywords: | Poisoning Randomized Controlled Trial Charcoal-administration and dosage Thevetia-poisoning Self-Injurious Behavior |
Issue Date: | 2003 |
Publisher: | Lancet Publishing Group |
Citation: | Lancet. 2003; 361(9373): pp.1935-38 |
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. FINDINGS: 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. INTERPRETATION: 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. |
Description: | Indexed in MEDLINE |
URI: | http://repository.kln.ac.lk/handle/123456789/1557 |
ISSN: | 0140-6736 (Print) 1474-547X (Electronic) |
Appears in Collections: | Journal/Magazine Articles |
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