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Activated Charcoal Offers No Improvement In Mortality After Self-Poisoning
In
the rural developing world, patients who have poisoned themselves with
toxic pesticides or plants should not be treated with multiple-dose
activated charcoal, because it has no effect on the rate of mortality.
These results were announced in an Article on February 16, 2008 in The
Lancet.
In
fact, a major clinical and public health problem in rural Asia is
self-poisoning by organophosphorus pesticides. Approximately 500,000
deaths restult in the region from self-inflicted harm, and
approximately 60 percent of these are due to pesticide poisoning. Of
these, about two thirds can be attributed to organiphosphorous
pesticides, about 200,000 per year.
Usually, to treat self-poisoning, doctors administer resuscitation,
antidotes, gastric
decontamination, and supportive care. No evidence has been shown that
gastric decontamination is effective, but the use of activated charcoal
is a commonly applied treatment method.
In developed countries, very few victims of self-poisoning die in the
hospital, so decontamination is not often applied. Usually treatment in
these countries involves pharmaceuticals. In developing countries, new
challenges are encountered. To investigate this, Dr Michael Eddleston,
Scottish Poisons Information Bureau, New Royal
Infirmary, Edinburgh, UK, and Professor David Warrell, University of
Oxford and John
Radcliffe Hospital, Oxford, UK, and colleagues performed a randomized
controlled trial of 4,632 self-poisoned patients in Sri Lanka to
establish the relative mortality in patients treated with charcoal at
various time intervals.
The population was divided approximately into thirds. One group, of
patients was administered six doses of 50 grams of activated charcoal
at regular four hour intervals; a second, was administered 50 grams of
activated charcoal once; the third were not treated with charcoal. Half
of the patients had digested pesticides, while about one third had
ingested seeds from yellow oleander (Thevetia peruviana)
Mortality did not differ between the three groups. The group given
multiple doses had 6.3% of the cases result in death, compared with
6.8% in the group given no charcoal. There was no discrepancy for
patients who took specific poisonous agents, were critically ill on
admission, or who presented earlier.
The authors conclude with a summary of the results: "This randomised,
controlled trial showed no
benefit from routine administration of multiple-dose activated charcoal
in Sri Lankan
district hospitals. Most patients had ingested yellow oleander seeds or
pesticides. Both poisons
have major effects that are delayed for several hours...absence of
benefit was seen
irrespective of the poison ingested or time to presentation."
Dr Peter Eyer, Walther Straub Institute of
Pharmacology and Toxicology, University of Munich, Germany and Dr
Florian Eyer,
Technical University, Munich, Germany, contributed to an accompanying
comment in the same issue: "The results of Eddleston and colleagues
study are
relevant for the setting of a developing country, where most of these
specific poisonings
occur...There is an obvious need for robust toxicokinetic studies to
select those poisons that are
potentially amenable to multidose activated charcoal. Clinical science
should meet basic
science and vice-versa."
Multiple-dose activated charcoal in acute self-poisoning: a
randomised controlled trial
Michael Eddleston, Edmund Juszczak, Nick A Buckley,Lalith
Senarathna,Fahim Mohamed,Wasantha Dissanayake, Ariyasena Hittarage,
Shifa Azher, K Jeganathan, Shaluka Jayamanne, M H Rezvi Sheriff, David
A Warrell for the Ox-Col Poisoning Study collaborators
The Lancet, Vol 371, February 16, 2008
Click
Here For Abstract
Written by Anna Sophia McKenney
Copyright: Start Sanatate
Not to be reproduced without permission of Start Sanatate
Cãrbunele activat nu ofera ameliorare a mortalitãþii dupã auto-otrãvire - Activated Charcoal Offers No Improvement In Mortality After Self-Poisoning - articole medicale engleza - startsanatate