Use of activated charcoal in poisoned patients aged over than 5 year old

Activated charcoal is the primary agent recommended for gastrointestinal decontamination. Current Canadian practices regarding its administration in poisoned patients are not well known. Our objectives were to measure the frequency of administration of activated charcoal in poisoned patient over the age of five, identify the potential determinants of its use, and describe the characteristics as well as the clinical outcomes in intoxicated patients.

In a multicenter health records review, we reviewed poisonings using data collected from health records between January 2015 and January 2016, at different hospitals in Quebec, Canada. We included all poisoned patients over the age of 5 who presented and were managed in the emergency department within 12 h of ingestion of a potentially toxic dose of a carbo-absorbable substance. The primary endpoint was the progression of toxicity, and the secondary endpoints were mortality and length of stay. We calculated the incidence of administration of activated charcoal and identified the observed side effects.

A total of 120 of the 935 poisoned patients received activated charcoal (12.8%). A short post-ingestion time (< 90 min) was the preferred indication for its administration. Charcoal-treated patients had a 9.2% lower risk of increased toxicity in the first 12 h, but twice the likelihood of being admitted to the hospital, and of having a length of stay of 12 h or more. The most common side effect was vomiting (20.8%). Only one of the patients who received it had aspiration pneumonia (0.01%) and two patients subsequently had gastrointestinal obstruction after receiving activated charcoal (0.02%).

Among patients who were poisoned with a carbo-absorbable substance, 12.8% were treated with activated charcoal in the emergency department. The majority of patients progressed well clinically. Our results will contribute to developing a protocol for a pan-Canadian prospective multicenter randomized controlled trial to evaluate the efficacy of activated charcoal in this population.