Study protocol: a randomised controlled trial of multiple and single dose activated charcoal for acute self-poisoning

The case fatality for intentional self-poisoning in rural Asia is 10-30 times higher than in the West, mostly due to the use of highly toxic poisons. Activated charcoal is a widely available intervention that may - if given early - bind to poisons in the stomach and prevent their absorption. Current...

Full description

Saved in:
Bibliographic Details
Published in:BMC emergency medicine 2007-05, Vol.7 (1), p.2-2, Article 2
Main Authors: Eddleston, Michael, Juszczak, Edmund, Buckley, Nick A, Senarathna, Lalith, Mohammed, Fahim, Allen, Stuart, Dissanayake, Wasantha, Hittarage, Ariyasena, Azher, Shifa, Jeganathan, K, Jayamanne, Shaluka, Sheriff, M H Rezvi, Warrell, David A
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-b575t-ae2fad9d69bc89ac290ce3b9abe1d00fc3ac71a410bde4d1e5da8027de5009fd3
cites cdi_FETCH-LOGICAL-b575t-ae2fad9d69bc89ac290ce3b9abe1d00fc3ac71a410bde4d1e5da8027de5009fd3
container_end_page 2
container_issue 1
container_start_page 2
container_title BMC emergency medicine
container_volume 7
creator Eddleston, Michael
Juszczak, Edmund
Buckley, Nick A
Senarathna, Lalith
Mohammed, Fahim
Allen, Stuart
Dissanayake, Wasantha
Hittarage, Ariyasena
Azher, Shifa
Jeganathan, K
Jayamanne, Shaluka
Sheriff, M H Rezvi
Warrell, David A
description The case fatality for intentional self-poisoning in rural Asia is 10-30 times higher than in the West, mostly due to the use of highly toxic poisons. Activated charcoal is a widely available intervention that may - if given early - bind to poisons in the stomach and prevent their absorption. Current guidelines recommend giving a single dose of charcoal (SDAC) if patients arrive within an hour of ingestion. Multiple doses (MDAC) may increase poison elimination at a later time by interrupting any enterohepatic or enterovascular circulations. The effectiveness of SDAC or MDAC is unknown. Since most patients present to hospital after one hour, we considered MDAC to have a higher likelihood of clinical benefit and set up a study to compare MDAC with no charcoal. A third arm of SDAC was added to help determine whether any benefit noted from MDAC resulted from the first dose or all doses. We set up a randomised controlled trial assessing the effectiveness of superactivated charcoal in unselected adult self-poisoning patients admitted to the adult medical wards of three Sri Lankan secondary hospitals. Patients were randomised to standard treatment or standard treatment plus either a single 50 g dose of superactivated charcoal dissolved in 300 ml of water or six doses every four hours. All patients with a history of poison ingestion were approached concerning the study and written informed consent taken from each patient, or their relative (for unconscious patients or those
doi_str_mv 10.1186/1471-227X-7-2
format article
fullrecord <record><control><sourceid>gale_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_915f66e5213c435988114eb85e7bb3cd</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A164451628</galeid><doaj_id>oai_doaj_org_article_915f66e5213c435988114eb85e7bb3cd</doaj_id><sourcerecordid>A164451628</sourcerecordid><originalsourceid>FETCH-LOGICAL-b575t-ae2fad9d69bc89ac290ce3b9abe1d00fc3ac71a410bde4d1e5da8027de5009fd3</originalsourceid><addsrcrecordid>eNp1ks1rFjEQhxdRbK0evcqC562Z7GaTeBBL8aNQ8KCCt5DPtynZzUuSLfS_b9YttS8qOWQ-fvMwzEzTvAZ0CsDGdzBQ6DCmvzra4SfN8YP_9JF91LzI-RohoAz48-YI6MAZZnDcLN_LYm7bfYol6hjet7JNcjZx8tmaVse5pBhCNUvyMrTRtdMSit8H21ZZm_28q6aJufq6-BtZ1rIrmXSschdTDS_FttkG1-2jz3GuJS-bZ06GbF_d_yfNz8-ffpx_7S6_fbk4P7vsFKGkdNJiJw03I1eacakxR9r2iktlwSDkdC81BTkAUsYOBiwxkiFMjSUIcWf6k-Zi45oor8U--UmmWxGlF78DMe2ETMXrYAUH4sbREgy9HnrCGQMYrGLEUqV6vbI-bKz9oiZrtK2jkeEAepiZ_ZXYxRsBjBEGtAI-bgDl438AhxkdJ7GuUKwrFFTgini7IXaytuxnF6tQ111pcQbjMBAYMauq03-o6jN28nWl1vkaPyjotgKdYs7JuoemAIn1yv5q483jUfxR359VfwcN9tE8</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Study protocol: a randomised controlled trial of multiple and single dose activated charcoal for acute self-poisoning</title><source>PubMed Central</source><creator>Eddleston, Michael ; Juszczak, Edmund ; Buckley, Nick A ; Senarathna, Lalith ; Mohammed, Fahim ; Allen, Stuart ; Dissanayake, Wasantha ; Hittarage, Ariyasena ; Azher, Shifa ; Jeganathan, K ; Jayamanne, Shaluka ; Sheriff, M H Rezvi ; Warrell, David A</creator><creatorcontrib>Eddleston, Michael ; Juszczak, Edmund ; Buckley, Nick A ; Senarathna, Lalith ; Mohammed, Fahim ; Allen, Stuart ; Dissanayake, Wasantha ; Hittarage, Ariyasena ; Azher, Shifa ; Jeganathan, K ; Jayamanne, Shaluka ; Sheriff, M H Rezvi ; Warrell, David A ; Ox-Col Poisoning Study collaborators ; the Ox-Col Poisoning Study collaborators</creatorcontrib><description>The case fatality for intentional self-poisoning in rural Asia is 10-30 times higher than in the West, mostly due to the use of highly toxic poisons. Activated charcoal is a widely available intervention that may - if given early - bind to poisons in the stomach and prevent their absorption. Current guidelines recommend giving a single dose of charcoal (SDAC) if patients arrive within an hour of ingestion. Multiple doses (MDAC) may increase poison elimination at a later time by interrupting any enterohepatic or enterovascular circulations. The effectiveness of SDAC or MDAC is unknown. Since most patients present to hospital after one hour, we considered MDAC to have a higher likelihood of clinical benefit and set up a study to compare MDAC with no charcoal. A third arm of SDAC was added to help determine whether any benefit noted from MDAC resulted from the first dose or all doses. We set up a randomised controlled trial assessing the effectiveness of superactivated charcoal in unselected adult self-poisoning patients admitted to the adult medical wards of three Sri Lankan secondary hospitals. Patients were randomised to standard treatment or standard treatment plus either a single 50 g dose of superactivated charcoal dissolved in 300 ml of water or six doses every four hours. All patients with a history of poison ingestion were approached concerning the study and written informed consent taken from each patient, or their relative (for unconscious patients or those &lt;16 yrs), recruited to the study. The exclusion criteria were: age under 14 yrs; prior treatment with activated charcoal during this poisoning episode; pregnancy; ingestion of a corrosive or hydrocarbon; requirement for oral medication; inability of the medical staff to intubate the patient with a Glasgow Coma Score &lt;13; presentation &gt;72 hrs post-ingestion, and previous recruitment. The primary outcome was in-hospital mortality; secondary outcomes included the occurrence of serious complications (need for intubation, time requiring assisted ventilation, fits, cardiac dysrhythmias). Analysis will be on an intention-to-treat basis; the effects of reported time to treatment after poisoning and status on admission will also be assessed. This trial will provide important information on the effectiveness of both single and multiple dose activated charcoal in the forms of poisoning commonly seen in rural Asia. If charcoal is found to be effective, it should be possible to make it widely available across rural Asia in an affordable formulation. Current Controlled Trials ISRCTN02920054.</description><identifier>ISSN: 1471-227X</identifier><identifier>EISSN: 1471-227X</identifier><identifier>DOI: 10.1186/1471-227X-7-2</identifier><identifier>PMID: 17498281</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Care and treatment ; Charcoal ; Drugs ; Health aspects ; Overdose ; Self-poisoning ; Statistics ; Study Protocol</subject><ispartof>BMC emergency medicine, 2007-05, Vol.7 (1), p.2-2, Article 2</ispartof><rights>COPYRIGHT 2007 BioMed Central Ltd.</rights><rights>Copyright © 2007 Eddleston et al; licensee BioMed Central Ltd. 2007 Eddleston et al; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b575t-ae2fad9d69bc89ac290ce3b9abe1d00fc3ac71a410bde4d1e5da8027de5009fd3</citedby><cites>FETCH-LOGICAL-b575t-ae2fad9d69bc89ac290ce3b9abe1d00fc3ac71a410bde4d1e5da8027de5009fd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885817/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885817/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17498281$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eddleston, Michael</creatorcontrib><creatorcontrib>Juszczak, Edmund</creatorcontrib><creatorcontrib>Buckley, Nick A</creatorcontrib><creatorcontrib>Senarathna, Lalith</creatorcontrib><creatorcontrib>Mohammed, Fahim</creatorcontrib><creatorcontrib>Allen, Stuart</creatorcontrib><creatorcontrib>Dissanayake, Wasantha</creatorcontrib><creatorcontrib>Hittarage, Ariyasena</creatorcontrib><creatorcontrib>Azher, Shifa</creatorcontrib><creatorcontrib>Jeganathan, K</creatorcontrib><creatorcontrib>Jayamanne, Shaluka</creatorcontrib><creatorcontrib>Sheriff, M H Rezvi</creatorcontrib><creatorcontrib>Warrell, David A</creatorcontrib><creatorcontrib>Ox-Col Poisoning Study collaborators</creatorcontrib><creatorcontrib>the Ox-Col Poisoning Study collaborators</creatorcontrib><title>Study protocol: a randomised controlled trial of multiple and single dose activated charcoal for acute self-poisoning</title><title>BMC emergency medicine</title><addtitle>BMC Emerg Med</addtitle><description>The case fatality for intentional self-poisoning in rural Asia is 10-30 times higher than in the West, mostly due to the use of highly toxic poisons. Activated charcoal is a widely available intervention that may - if given early - bind to poisons in the stomach and prevent their absorption. Current guidelines recommend giving a single dose of charcoal (SDAC) if patients arrive within an hour of ingestion. Multiple doses (MDAC) may increase poison elimination at a later time by interrupting any enterohepatic or enterovascular circulations. The effectiveness of SDAC or MDAC is unknown. Since most patients present to hospital after one hour, we considered MDAC to have a higher likelihood of clinical benefit and set up a study to compare MDAC with no charcoal. A third arm of SDAC was added to help determine whether any benefit noted from MDAC resulted from the first dose or all doses. We set up a randomised controlled trial assessing the effectiveness of superactivated charcoal in unselected adult self-poisoning patients admitted to the adult medical wards of three Sri Lankan secondary hospitals. Patients were randomised to standard treatment or standard treatment plus either a single 50 g dose of superactivated charcoal dissolved in 300 ml of water or six doses every four hours. All patients with a history of poison ingestion were approached concerning the study and written informed consent taken from each patient, or their relative (for unconscious patients or those &lt;16 yrs), recruited to the study. The exclusion criteria were: age under 14 yrs; prior treatment with activated charcoal during this poisoning episode; pregnancy; ingestion of a corrosive or hydrocarbon; requirement for oral medication; inability of the medical staff to intubate the patient with a Glasgow Coma Score &lt;13; presentation &gt;72 hrs post-ingestion, and previous recruitment. The primary outcome was in-hospital mortality; secondary outcomes included the occurrence of serious complications (need for intubation, time requiring assisted ventilation, fits, cardiac dysrhythmias). Analysis will be on an intention-to-treat basis; the effects of reported time to treatment after poisoning and status on admission will also be assessed. This trial will provide important information on the effectiveness of both single and multiple dose activated charcoal in the forms of poisoning commonly seen in rural Asia. If charcoal is found to be effective, it should be possible to make it widely available across rural Asia in an affordable formulation. Current Controlled Trials ISRCTN02920054.</description><subject>Care and treatment</subject><subject>Charcoal</subject><subject>Drugs</subject><subject>Health aspects</subject><subject>Overdose</subject><subject>Self-poisoning</subject><subject>Statistics</subject><subject>Study Protocol</subject><issn>1471-227X</issn><issn>1471-227X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNp1ks1rFjEQhxdRbK0evcqC562Z7GaTeBBL8aNQ8KCCt5DPtynZzUuSLfS_b9YttS8qOWQ-fvMwzEzTvAZ0CsDGdzBQ6DCmvzra4SfN8YP_9JF91LzI-RohoAz48-YI6MAZZnDcLN_LYm7bfYol6hjet7JNcjZx8tmaVse5pBhCNUvyMrTRtdMSit8H21ZZm_28q6aJufq6-BtZ1rIrmXSschdTDS_FttkG1-2jz3GuJS-bZ06GbF_d_yfNz8-ffpx_7S6_fbk4P7vsFKGkdNJiJw03I1eacakxR9r2iktlwSDkdC81BTkAUsYOBiwxkiFMjSUIcWf6k-Zi45oor8U--UmmWxGlF78DMe2ETMXrYAUH4sbREgy9HnrCGQMYrGLEUqV6vbI-bKz9oiZrtK2jkeEAepiZ_ZXYxRsBjBEGtAI-bgDl438AhxkdJ7GuUKwrFFTgini7IXaytuxnF6tQ111pcQbjMBAYMauq03-o6jN28nWl1vkaPyjotgKdYs7JuoemAIn1yv5q483jUfxR359VfwcN9tE8</recordid><startdate>20070511</startdate><enddate>20070511</enddate><creator>Eddleston, Michael</creator><creator>Juszczak, Edmund</creator><creator>Buckley, Nick A</creator><creator>Senarathna, Lalith</creator><creator>Mohammed, Fahim</creator><creator>Allen, Stuart</creator><creator>Dissanayake, Wasantha</creator><creator>Hittarage, Ariyasena</creator><creator>Azher, Shifa</creator><creator>Jeganathan, K</creator><creator>Jayamanne, Shaluka</creator><creator>Sheriff, M H Rezvi</creator><creator>Warrell, David A</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20070511</creationdate><title>Study protocol: a randomised controlled trial of multiple and single dose activated charcoal for acute self-poisoning</title><author>Eddleston, Michael ; Juszczak, Edmund ; Buckley, Nick A ; Senarathna, Lalith ; Mohammed, Fahim ; Allen, Stuart ; Dissanayake, Wasantha ; Hittarage, Ariyasena ; Azher, Shifa ; Jeganathan, K ; Jayamanne, Shaluka ; Sheriff, M H Rezvi ; Warrell, David A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b575t-ae2fad9d69bc89ac290ce3b9abe1d00fc3ac71a410bde4d1e5da8027de5009fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Care and treatment</topic><topic>Charcoal</topic><topic>Drugs</topic><topic>Health aspects</topic><topic>Overdose</topic><topic>Self-poisoning</topic><topic>Statistics</topic><topic>Study Protocol</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eddleston, Michael</creatorcontrib><creatorcontrib>Juszczak, Edmund</creatorcontrib><creatorcontrib>Buckley, Nick A</creatorcontrib><creatorcontrib>Senarathna, Lalith</creatorcontrib><creatorcontrib>Mohammed, Fahim</creatorcontrib><creatorcontrib>Allen, Stuart</creatorcontrib><creatorcontrib>Dissanayake, Wasantha</creatorcontrib><creatorcontrib>Hittarage, Ariyasena</creatorcontrib><creatorcontrib>Azher, Shifa</creatorcontrib><creatorcontrib>Jeganathan, K</creatorcontrib><creatorcontrib>Jayamanne, Shaluka</creatorcontrib><creatorcontrib>Sheriff, M H Rezvi</creatorcontrib><creatorcontrib>Warrell, David A</creatorcontrib><creatorcontrib>Ox-Col Poisoning Study collaborators</creatorcontrib><creatorcontrib>the Ox-Col Poisoning Study collaborators</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>BMC emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eddleston, Michael</au><au>Juszczak, Edmund</au><au>Buckley, Nick A</au><au>Senarathna, Lalith</au><au>Mohammed, Fahim</au><au>Allen, Stuart</au><au>Dissanayake, Wasantha</au><au>Hittarage, Ariyasena</au><au>Azher, Shifa</au><au>Jeganathan, K</au><au>Jayamanne, Shaluka</au><au>Sheriff, M H Rezvi</au><au>Warrell, David A</au><aucorp>Ox-Col Poisoning Study collaborators</aucorp><aucorp>the Ox-Col Poisoning Study collaborators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Study protocol: a randomised controlled trial of multiple and single dose activated charcoal for acute self-poisoning</atitle><jtitle>BMC emergency medicine</jtitle><addtitle>BMC Emerg Med</addtitle><date>2007-05-11</date><risdate>2007</risdate><volume>7</volume><issue>1</issue><spage>2</spage><epage>2</epage><pages>2-2</pages><artnum>2</artnum><issn>1471-227X</issn><eissn>1471-227X</eissn><abstract>The case fatality for intentional self-poisoning in rural Asia is 10-30 times higher than in the West, mostly due to the use of highly toxic poisons. Activated charcoal is a widely available intervention that may - if given early - bind to poisons in the stomach and prevent their absorption. Current guidelines recommend giving a single dose of charcoal (SDAC) if patients arrive within an hour of ingestion. Multiple doses (MDAC) may increase poison elimination at a later time by interrupting any enterohepatic or enterovascular circulations. The effectiveness of SDAC or MDAC is unknown. Since most patients present to hospital after one hour, we considered MDAC to have a higher likelihood of clinical benefit and set up a study to compare MDAC with no charcoal. A third arm of SDAC was added to help determine whether any benefit noted from MDAC resulted from the first dose or all doses. We set up a randomised controlled trial assessing the effectiveness of superactivated charcoal in unselected adult self-poisoning patients admitted to the adult medical wards of three Sri Lankan secondary hospitals. Patients were randomised to standard treatment or standard treatment plus either a single 50 g dose of superactivated charcoal dissolved in 300 ml of water or six doses every four hours. All patients with a history of poison ingestion were approached concerning the study and written informed consent taken from each patient, or their relative (for unconscious patients or those &lt;16 yrs), recruited to the study. The exclusion criteria were: age under 14 yrs; prior treatment with activated charcoal during this poisoning episode; pregnancy; ingestion of a corrosive or hydrocarbon; requirement for oral medication; inability of the medical staff to intubate the patient with a Glasgow Coma Score &lt;13; presentation &gt;72 hrs post-ingestion, and previous recruitment. The primary outcome was in-hospital mortality; secondary outcomes included the occurrence of serious complications (need for intubation, time requiring assisted ventilation, fits, cardiac dysrhythmias). Analysis will be on an intention-to-treat basis; the effects of reported time to treatment after poisoning and status on admission will also be assessed. This trial will provide important information on the effectiveness of both single and multiple dose activated charcoal in the forms of poisoning commonly seen in rural Asia. If charcoal is found to be effective, it should be possible to make it widely available across rural Asia in an affordable formulation. Current Controlled Trials ISRCTN02920054.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>17498281</pmid><doi>10.1186/1471-227X-7-2</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1471-227X
ispartof BMC emergency medicine, 2007-05, Vol.7 (1), p.2-2, Article 2
issn 1471-227X
1471-227X
language eng
recordid cdi_doaj_primary_oai_doaj_org_article_915f66e5213c435988114eb85e7bb3cd
source PubMed Central
subjects Care and treatment
Charcoal
Drugs
Health aspects
Overdose
Self-poisoning
Statistics
Study Protocol
title Study protocol: a randomised controlled trial of multiple and single dose activated charcoal for acute self-poisoning
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-18T09%3A44%3A42IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Study%20protocol:%20a%20randomised%20controlled%20trial%20of%20multiple%20and%20single%20dose%20activated%20charcoal%20for%20acute%20self-poisoning&rft.jtitle=BMC%20emergency%20medicine&rft.au=Eddleston,%20Michael&rft.aucorp=Ox-Col%20Poisoning%20Study%20collaborators&rft.date=2007-05-11&rft.volume=7&rft.issue=1&rft.spage=2&rft.epage=2&rft.pages=2-2&rft.artnum=2&rft.issn=1471-227X&rft.eissn=1471-227X&rft_id=info:doi/10.1186/1471-227X-7-2&rft_dat=%3Cgale_doaj_%3EA164451628%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-b575t-ae2fad9d69bc89ac290ce3b9abe1d00fc3ac71a410bde4d1e5da8027de5009fd3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_id=info:pmid/17498281&rft_galeid=A164451628&rfr_iscdi=true