Is an activated charcoal necessary as a routine treatment for drug overdose patients who do not required intubation?

• Published in: Nihon Kyukyu Igakukai Zasshi Vol. 20; no. 2; pp. 77 - 83
• Main Authors: Hagiwara, Yusuke, Kimura, Akio, Sato, Morihito, Sugimoto, Noriko, Inaka, Aki, Sakamoto, Taigo, Shimbo, Takuro
• Format: Journal Article
• Language: Japanese
• Published: Japanese Association for Acute Medicine 15.02.2009
• Subjects: emergency room (ER); matching; position statement; propensity score
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.20.77

Background: Cases of drug overdoses are common in emergency departments. There are specific treatments such as a gastric lavage or activated charcoal. A Position Statement was presented in 1997, and a standard treatment was presented by the Japanese Society for Clinical Toxicology. Standardization of medical treatments for poisonings is a global goal. Purpose: We reviewed whether activated charcoal improved clinical outcomes in drug overdose patients who did not require intubation. Object and Methods: We conducted a retrospective review of drug overdose patients transported by ambulance to the Emergency Department of the International Medical Center of Japan between January 1, 2005 and December 31, 2007. 572 drug overdose patients were admitted, 484 (activated charcoal; 121 patients, control 363 patients) did not require intubation. We compared the number of hospital days of the activated charcoal group with that of the control group. We also investigated complications after activated charcoal treatment. Results: No deaths were recorded. The number of hospital days for the activated charcoal group was 1.92 ± 0.95 days and the control group was 1.94 ± 0.95 days. There was no significant difference (p= 0.81), with the difference being just -0.02 days; 95% confidence interval, -0.22∼0.17. To control for corresponding factors, patients were assigned to one of two groups and matched using propensity scores. There were 89 patients-pairs (178 patients). The number of hospital days for these two groups were 1.80 ± 0.91 (activated charcoal) and 1.85 ± 0.95 (control), respectively. Similarly, there was no significant difference (p= 0.69), and the difference of the number of hospital days was -0.06 days; 95% confidence interval was -0.33∼0.22. Although vomiting after activated charcoal treatment was seen in 14 (11.6%) of the 121 patients, no aspiration pneumonia was considered to have been caused by activated charcoal. Conclusion: It was suggested that activated charcoal is unnecessary as a routine treatment for drug overdose patients who do not require intubation.