QJM Advance Access originally published online on July 22, 2005
QJM 2005 98(9):655-660; doi:10.1093/qjmed/hci102
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A randomized clinical trial of activated charcoal for the routine management of oral drug overdose
From the 1Pharmacy, University of Canberra, Bruce, 2Centre for Education and Research on Ageing and ANZAC Research Institute, University of Sydney, Concord Repatriation General Hospital, Concord, and Departments of 3Emergency Medicine and 4Clinical Pharmacology and Toxicology, Canberra Clinical School, The Canberra Hospital, Canberra, Australia
Address correspondence to Associate Professor G.M. Cooper, Head of Pharmacy, University of Canberra, Bruce, ACT 2601, Australia. email: gabrielle.cooper{at}canberra.edu.au
Received 23 November 2004 and in revised form 23 June 2005
Background: Activated charcoal (AC) is commonly used for the routine management of oral drug overdose.
Aim: To determine whether the routine use of activated charcoal has an effect on patient outcomes.
Design: Randomized controlled unblinded trial.
Methods: We recruited all adult patients presenting with an oral overdose at The Canberra Hospital, excluding only transfers, late presenters, those who had ingested drugs not adsorbed by activated charcoal or where administration was contraindicated, and very serious ingestions (at the discretion of the admitting physician). Patients were randomized to either activated charcoal or no decontamination.
Results: The trial recruited 327 patients over 16 months. Of 411 presentations, four refused consent, 27 were protocol violations and 53 were excluded from the trial. Only seven were excluded due to the severity of their ingestion. The most common substances ingested were benzodiazepines, paracetamol and selective serotonin reuptake inhibitor antidepressants. More than 80% of patients presented within 4 h following ingestion. There were no differences between AC and no decontamination in terms of length of stay (AC 6.75 h, IQR 4–14 vs. controls 5.5 h, IQR 3–12; p = 0.11) or secondary outcomes including vomiting, mortality and intensive care admission.
Discussion: Routine administration of charcoal following oral overdose did not significantly influence length of stay or other patient outcomes following oral drug overdose. There were few adverse events. This does not exclude a role in patients who present shortly after ingestion of highly lethal drugs.
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