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.2014-10-292014-10-292003Lancet. 2003; 361(9373): pp.1935-380140-6736 (Print)1474-547X (Electronic)http://repository.kln.ac.lk/handle/123456789/1557Indexed in MEDLINEBACKGROUND: 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.PoisoningRandomized Controlled TrialCharcoal-administration and dosageThevetia-poisoningSelf-Injurious BehaviorArticlePharmacologyMedicinePublic Health