Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial

Area of Science:

• Toxicology
• Clinical Toxicology
• Public Health

Background:

• Intentional self-poisoning has a significantly higher case-fatality rate in developing countries compared to industrialized nations.
• This disparity is largely attributed to the use of highly toxic pesticides and plants in rural areas.
• The study investigated activated charcoal as a potential intervention to reduce mortality.

Purpose of the Study:

• To assess the efficacy of multiple-dose activated charcoal in reducing mortality from intentional self-poisoning in a rural developing country setting.
• To compare the outcomes of no charcoal, single-dose activated charcoal, and multiple-dose activated charcoal treatments.

Main Methods:

• An open-label, randomized controlled trial was conducted in three Sri Lankan hospitals.
• 4632 patients were randomized to receive no charcoal, one 50g dose, or six 50g doses of activated charcoal at 4-hour intervals.
• The primary outcome measure was mortality, with analysis performed by intention to treat.

Main Results:

• Mortality rates did not significantly differ between the no charcoal (6.8%), single-dose (6.3%), and multiple-dose (6.3%) activated charcoal groups.
• No significant differences in outcomes were observed based on the type of poison ingested, severity of illness on admission, or time of presentation.
• The adjusted odds ratio for mortality in the multiple-dose group compared to the no charcoal group was 0.96 (95% CI 0.70-1.33).

Conclusions:

• Routine use of multiple-dose activated charcoal cannot be recommended for intentional self-poisoning in the rural Asia Pacific region.
• Further research into the early administration of activated charcoal may be beneficial.
• There is an urgent need for the development of effective and affordable treatments for pesticide and plant ingestion in these areas.