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Multiple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial

de Silva, H. A., Fonseka, M. M. D., Pathmeswaran, A., Alahakone, D. G. S., Ratnatilake, G. A., Gunatilake, S. B., Ranasinha, C. D., Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200, Aronson, J. K. and de Silva, H. J. (2003) 'Multiple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial'. Lancet, Vol 361, Issue 9373, pp. 1935-1938.

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Abstract

Background: Deliberate self-poisoning with yellow oleander seeds is common in Sri Lanka and is associated with severe cardiac toxicity and a mortality rate of about 10%. Specialised treatment with antidigoxin Fab fragments and temporary cardiac pacing is expensive and not widely available. Multiple-dose activated charcoal binds cardiac glycosides in the gut lumen and promotes their elimination. We aimed to assess the efficacy of multiple-dose activated charcoal in the treatment of patients with yellow-oleander poisoning. Methods: On admission, participants received one dose of activated charcoal and were then randomly assigned either 50 g of activated charcoal every 6 h for 3 days or sterile water as placebo. A standard treatment protocol was used in all patients. We monitored cardiac rhythm and did 12-lead electocardiographs as needed. Death was the primary endpoint, and secondary endpoints were life-threatening cardiac arrhythmias, dose of atropine used, need for cardiac pacing, admission to intensive care, and number of days in hospital. Analysis was by intention to treat. Findings: 201 patients received multiple-dose activated charcoal and 200 placebo. There were fewer deaths in the treatment group (five [2.5%] vs 16 [8%]; percentage difference 5.5%; 95% Cl 0.6-10.3; p=0.025), and we noted difference in favour of the treatment group for all secondary endpoints, apart from number of days in hospital. The drug was safe and well tolerated. Interpretation: Multiple-dose activated charcoal is effective in reducing deaths and life-threatening cardiac arrhythmias after yellow oleander poisoning and should be considered in all patients.Use of activated charcoal could reduce the cost of treatment.

Item Type: Article
Subjects: QV Pharmacology > Toxicology > General Toxicology > QV 601 Antidotes and other therapeutic measures
QW Microbiology and Immunology > Antigens and Antibodies. Toxins and Antitoxins > QW 630 Toxins. Antitoxins
WB Practice of Medicine > Therapeutics > WB 330 Drug therapy
WG Cardiovascular System > WG 120 Cardiovascular diseases
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI): https://doi.org/10.1016/s0140-6736(03)13581-7
Depositing User: Users 476 not found.
Date Deposited: 08 Feb 2013 13:42
Last Modified: 06 Feb 2018 13:04
URI: http://archive.lstmed.ac.uk/id/eprint/2521

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