1
|
Hoegberg LCG, Shepherd G, Wood DM, Johnson J, Hoffman RS, Caravati EM, Chan WL, Smith SW, Olson KR, Gosselin S. Systematic review on the use of activated charcoal for gastrointestinal decontamination following acute oral overdose. Clin Toxicol (Phila) 2021; 59:1196-1227. [PMID: 34424785 DOI: 10.1080/15563650.2021.1961144] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The use of activated charcoal in poisoning remains both a pillar of modern toxicology and a source of debate. Following the publication of the joint position statements on the use of single-dose and multiple-dose activated charcoal by the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists, the routine use of activated charcoal declined. Over subsequent years, many new pharmaceuticals became available in modified or alternative-release formulations and additional data on gastric emptying time in poisoning was published, challenging previous assumptions about absorption kinetics. The American Academy of Clinical Toxicology, the European Association of Poison Centres and Clinical Toxicologists and the Asia Pacific Association of Medical Toxicology founded the Clinical Toxicology Recommendations Collaborative to create a framework for evidence-based recommendations for the management of poisoned patients. The activated charcoal workgroup of the Clinical Toxicology Recommendations Collaborative was tasked with reviewing systematically the evidence pertaining to the use of activated charcoal in poisoning in order to update the previous recommendations. OBJECTIVES The main objective was: Does oral activated charcoal given to adults or children prevent toxicity or improve clinical outcome and survival of poisoned patients compared to those who do not receive charcoal? Secondary objectives were to evaluate pharmacokinetic outcomes, the role of cathartics, and adverse events to charcoal administration. This systematic review summarizes the available evidence on the efficacy of activated charcoal. METHODS A medical librarian created a systematic search strategy for Medline (Ovid), subsequently translated for Embase (via Ovid), CINAHL (via EBSCO), BIOSIS Previews (via Ovid), Web of Science, Scopus, and the Cochrane Library/DARE. All databases were searched from inception to December 31, 2019. There were no language limitations. One author screened all citations identified in the search based on predefined inclusion/exclusion criteria. Excluded citations were confirmed by an additional author and remaining articles were obtained in full text and evaluated by at least two authors for inclusion. All authors cross-referenced full-text articles to identify articles missed in the searches. Data from included articles were extracted by the authors on a standardized spreadsheet and two authors used the GRADE methodology to independently assess the quality and risk of bias of each included study. RESULTS From 22,950 titles originally identified, the final data set consisted of 296 human studies, 118 animal studies, and 145 in vitro studies. Also included were 71 human and two animal studies that reported adverse events. The quality was judged to have a Low or Very Low GRADE in 469 (83%) of the studies. Ninety studies were judged to be of Moderate or High GRADE. The higher GRADE studies reported on the following drugs: paracetamol (acetaminophen), phenobarbital, carbamazepine, cardiac glycosides (digoxin and oleander), ethanol, iron, salicylates, theophylline, tricyclic antidepressants, and valproate. Data on newer pharmaceuticals not reviewed in the previous American Academy of Clinical Toxicology/European Association of Poison Centres and Clinical Toxicologists statements such as quetiapine, olanzapine, citalopram, and Factor Xa inhibitors were included. No studies on the optimal dosing for either single-dose or multiple-dose activated charcoal were found. In the reviewed clinical data, the time of administration of the first dose of charcoal was beyond one hour in 97% (n = 1006 individuals), beyond two hours in 36% (n = 491 individuals), and beyond 12 h in 4% (n = 43 individuals) whereas the timing of the first dose in controlled studies was within one hour of ingestion in 48% (n = 2359 individuals) and beyond two hours in 36% (n = 484) of individuals. CONCLUSIONS This systematic review found heterogenous data. The higher GRADE data was focused on a few select poisonings, while studies that addressed patients with unknown and or mixed ingestions were hampered by low rates of clinically meaningful toxicity or death. Despite these limitations, they reported a benefit of activated charcoal beyond one hour in many clinical scenarios.
Collapse
Affiliation(s)
- Lotte C G Hoegberg
- Department of Anesthesiology, The Danish Poisons Information Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Greene Shepherd
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jami Johnson
- Oklahoma Center for Poison and Drug Information, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - E Martin Caravati
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Wui Ling Chan
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Silas W Smith
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Kent R Olson
- California Poison Control System, San Francisco Division, University of California, San Francisco, California
| | - Sophie Gosselin
- Emergency Department CISSS Montérégie Centre, Greenfield Park, Canada.,Centre antipoison du Québec, Québec, Canada.,Department of Emergency Medicine, McGill Faculty of Medicine, Montreal, Canada
| |
Collapse
|
2
|
Caudill MN, Stilwell JM, Howerth EW, Garner B. Chronic granulomatous pneumonia and lung rupture secondary to aspiration of activated charcoal in a French Bulldog. Vet Clin Pathol 2019; 48:67-70. [DOI: 10.1111/vcp.12700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Bridget Garner
- Department of Pathology University of Georgia Athens Georgia
| |
Collapse
|
3
|
A review of published case reports of inadvertent pulmonary placement of nasogastric tubes in children. J Pediatr Nurs 2014; 29:e7-12. [PMID: 24071621 DOI: 10.1016/j.pedn.2013.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/24/2013] [Indexed: 01/12/2023]
Abstract
PROBLEM Little is known about the incidence of inadvertent pulmonary placement of nasogastric tubes during blind insertions in children. PURPOSE The purpose of this paper was to conduct a review of published case reports over the past two decades. METHODS An OVID Medline search was conducted of articles published from 1993 through 2012. RESULTS Fifteen published case reports were located; four patients died as a result of their malpositioned tubes. The auscultatory bedside method failed to detect the malpositioned tubes in all seven cases in which it was used. CONCLUSIONS The incidence of inadvertent pulmonary placement of nasogastric tubes is relatively low but can lead to serious and even lethal results in children. The auscultatory method to predict tube location is unreliable.
Collapse
|
4
|
Gunaydın M, Guzel A, Guzel A, Alacam H, Salis O, Murat N, Gacar A, Guvenc T. The effect of curcumin on lung injuries in a rat model induced by aspirating gastrointestinal decontamination agents. J Pediatr Surg 2012; 47:1669-76. [PMID: 22974604 DOI: 10.1016/j.jpedsurg.2012.01.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 01/16/2012] [Accepted: 01/16/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aspiration is one of the most feared complications of gastrointestinal decontamination procedures with nonabsorbed polyethylene glycol (PEG) solution and activated charcoal (AC). We aimed to investigate the protective effects of curcumin (CUR) on lung injury in rats induced by aspiration of these agents. METHODS Experimental rats were divided randomly into 6 groups (n = 7): a saline-aspirated control (group I), sterile saline aspirated with CUR treatment (group II), PEG aspirated (group III), PEG aspirated with CUR treatment (group IV), AC aspirated (group V), and AC aspirated with CUR treatment (group VI). After aspiration, treatment groups II, IV, and VI were given 150 mg/kg CUR intraperitoneally once a day for 7 days. After 7 days, the rats were humanely killed, and both the lungs and serum specimens from all groups were evaluated histopathologically, immunohistochemically, and biochemically. RESULTS Aspiration of gastrointestinal decontamination agents produced histopathologic changes, elevated levels of malondialdehyde and surfactant protein D, reduced levels of antioxidant enzymes, and increased expression of inflammatory cytokines interleukin-1β and tumor necrosis factor α. Curcumin treatments effectively attenuated the rats' pulmonary inflammation responses (as shown by reduced alveolar damage), decreased serum malondialdehyde and surfactant protein D levels, and inhibited the expressions of tumor necrosis factor α and interleukin-1β. CONCLUSIONS Because of its anti-inflammatory effects, CUR treatment may have preventive effects on lung injuries induced by aspirating gastrointestinal decontamination agents.
Collapse
Affiliation(s)
- Mithat Gunaydın
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun 55030, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Güzel A, Günaydin M, Güzel A, Alaçam H, Murat N, Gacar A, Güvenç T. Infliximab attenuates activated charcoal and polyethylene glycol aspiration-induced lung injury in rats. Exp Lung Res 2012; 38:147-56. [DOI: 10.3109/01902148.2012.659836] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
6
|
Güzel A, Güzel A, Günaydin M, Alaçam H, Saliş O, Sükrü Paksu M, Murat N, Gacar A, Güvenç T. The role of iNOS inhibitors on lung injury induced by gastrointestinal decontamination agents aspiration. J Mol Histol 2012; 43:351-60. [PMID: 22374168 DOI: 10.1007/s10735-012-9397-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 02/20/2012] [Indexed: 11/29/2022]
Abstract
Aspiration is a devastating complication during decontamination procedure in poisoning patients. We have investigated whether S-methylisothiourea protects different pulmonary aspiration gastrointestinal decontamination agent-induced lung injury in rats. Forty-two male Sprague-Dawley rats were assigned to one of six groups (n = 7): normal saline, activated charcoal, polyethylene glycol, normal saline + S-methylisothiourea treated activated charcoal + S-methylisothiourea treated and polyethylene glycol + S-methylisothiourea treated. Normal saline, activated aharcoal and polyethylene glycol were instilled into the lungs. The rats received S-methylisothiourea i.p twice daily for 7 days. Serum surfactant protein D, oxidative stress products and inducible nitric oxide synthase expression in the lung were investigated. The aspiration of activated charcoal significantly increased all histopathological scores (P < 0.01). Only peribronchial inflammatory cell infiltration, alveolar edema, and alveolar histiocytes were increased in the polyethylene glycol groups as compared to the normal saline group (P < 0.05). Pulmonary aspiration increased serum malondialdehyde (P < 0.001), and surfactant protein D (P < 0.05) levels and decreased serum superoxide dismutase levels (P < 0.05). S-methylisothiourea treatment decreased all histopathological scores in the activated charcoal treated S-methylisothiourea group (P < 0.01) and only decreased alveolar edema and alveolar histiocytes in the polyethylene glycol-treated S-methylisothiourea group (P < 0.05). S-methylisothiourea treatment reduced elevated oxidative factors, inducible nitric oxide synthase activity and serum surfactant protein D levels. Our findings showed that S-methylisothiourea may be a protective drug against Activated Charcoal and Polyethylene Glycol-induced lung injury.
Collapse
Affiliation(s)
- Ahmet Güzel
- Faculty of Medicine, Department of Pediatrics, Ondokuz Mayıs University, 55139 Kurupelit, Samsun, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Kim YI, Park JS, Choi JS, Jou SS, Gil HW, Hong SY. Five Successful Experiences in the Treatment of Charcoal Aspiration with Bronchoscopic Toilet - A Case Report -. Korean J Crit Care Med 2012. [DOI: 10.4266/kjccm.2012.27.3.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Young Il Kim
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae-Seok Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae Sung Choi
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sung-Shik Jou
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyo-Wook Gil
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sae-Yong Hong
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| |
Collapse
|
8
|
Lee HM, Park JS, Kim JY, Lee JY, Ahn BK, Gil HW, Choi JS. A Case of Activated Charcoal Aspiration Treated by Early and Repeated Bronchoalveolar Lavage. Tuberc Respir Dis (Seoul) 2012. [DOI: 10.4046/trd.2012.72.2.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Han Min Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae-Seok Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae Yun Kim
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ji Yeon Lee
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Byung Kyu Ahn
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyo-Wook Gil
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae-Sung Choi
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| |
Collapse
|
9
|
American Academy of Clinical Toxico, European Association of Poisons Cen. Position Paper: Single-Dose Activated Charcoal. Clin Toxicol (Phila) 2008. [DOI: 10.1081/clt-51867] [Citation(s) in RCA: 291] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
10
|
Acute respiratory failure after aspiration of activated charcoal with recurrent deposition and release from an intrapulmonary cavern. Intensive Care Med 2008; 35:360-3. [PMID: 18795259 DOI: 10.1007/s00134-008-1259-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 08/20/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report on the recurrent release of charcoal from an intrapulmonary cavern in a case of acute respiratory failure after charcoal aspiration. DESIGN Case report. SETTING Anaesthesiological ICU, university hospital. PATIENT An 18-year-old ethanol intoxicated comatose patient regurgitated and aspirated activated charcoal during orotracheal intubation. TREATMENT After 2 days of mechanical ventilation, the patient was transferred to a tertiary care university hospital. On admission, acute respiratory distress syndrome with bilateral pulmonary infiltrations was diagnosed. The patient's recovery was hampered by recurrent release of charcoal from an intrapulmonary cavern. Sophisticated ventilatory support, prone positioning, secretolytics, repetitive bronchoscopy, and antibiotic therapy may have facilitated bronchoalveolar clearance and weaning after 18 days. CONCLUSION Aspiration may be a dramatic complication if charcoal is administered in comatose patients without airway protection. In this case report, advanced intensive care measures were necessary to tackle the special feature of charcoal release from an intrapulmonary cavern.
Collapse
|
11
|
Babu KM, Church RJ, Lewander W. Energy Drinks: The New Eye-Opener For Adolescents. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2008. [DOI: 10.1016/j.cpem.2007.12.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
12
|
Reid SM, Neto GM, Clifford TJ, Randhawa N, Plint A. Use of single-dose activated charcoal among Canadian pediatric emergency physicians. Pediatr Emerg Care 2006; 22:724-8. [PMID: 17047472 DOI: 10.1097/01.pec.0000236829.31571.a6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Gastric decontamination with single-dose activated charcoal (SDAC) is a mainstay in emergency department (ED) treatment of ingestions. Guidelines updated in 2005 encourage practitioners to use SDAC only in toxic ingestions presenting within 1 hour. Despite these guidelines, adult studies demonstrate a significant lack of consensus. This study examined the proposed use of SDAC for gastric decontamination in common pediatric ingestion scenarios by emergency physicians working in Canadian pediatric EDs. METHODS A standardized survey consisting of 5 clinical scenarios was mailed to all physicians with a primary clinical appointment to the ED at 9 Canadian children's hospitals. RESULTS One hundred thirty-one physicians were surveyed, and 95 (72%) responded. The majority of respondents were pediatricians (68.1%) with a mean of 15.0 years of experience (SD, 6.8 years). Of those surveyed; 91 (97.8%) would use SDAC for a toxic ingestion presenting in less than 1 hour; 35 (36.8%) would use SDAC for a toxic ingestion presenting after 3 hours; 61 (64.9%) would use SDAC for a nontoxic exploratory ingestion presenting in less than 1 hour; and 29 (30.5%) would use SDAC for a mildly symptomatic intentional ingestion presenting at an unknown time. Eleven (11.7%) would use SDAC for an ingestion of a substance that does not adsorb to SDAC. CONCLUSIONS There is variation in the use of SDAC among emergency physicians working in Canadian pediatric EDs. This variation suggests that optimal management is not clear and that continued education and research are required.
Collapse
Affiliation(s)
- Sarah M Reid
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
| | | | | | | | | |
Collapse
|
13
|
Huber M, Pohl W, Reinisch G, Attems J, Pescosta S, Lintner F. Lung disease 35 years after aspiration of activated charcoal in combination with pulmonary lymphangioleiomyomatosis. A histological and clinicopathological study with scanning electron microscopic evaluation and element analysis. Virchows Arch 2006; 449:225-9. [PMID: 16775697 DOI: 10.1007/s00428-006-0236-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 05/14/2006] [Indexed: 10/24/2022]
Abstract
Activated charcoal provides effective treatment for most toxic ingestions. Accidental aspiration of activated charcoal is rare. Previously, there have been a few single cases reported on charcoal-related pulmonary complications. We describe an unusual case of pulmonary lesions 35 years after accidental aspiration of activated charcoal. The 38-year-old female patient presented with recurrent pneumothorax. A routinely performed chest roentgenogram revealed pulmonary lesions, highly suggestive to lymphangioleiomyomatosis (LAM). Histopathological investigation of the lung tissue demonstrated some features of LAM but showed prominent pneumoconiotic lesions with cystic tissue destruction. The pneumoconiotic reaction was characterized by prominent black deposits accompanied by foreign-body granuloma formation and minimal fibrosis. Scanning electron microscopic investigation of these deposits showed particles measuring up to 300 microm in greatest diameter. Energy-dispersive X-ray spectra of these particles revealed carbon-rich material, presumably charcoal. The aspiration event was confirmed by the clinical history. To our knowledge, this is the first report not only on a long-term follow-up after aspiration of activated charcoal but also on charcoal-related pulmonary lesions in combination with LAM.
Collapse
Affiliation(s)
- M Huber
- Otto Wagner Hospital, Institute of Pathology and Bacteriology, Baumgartner Hoehe 1, Vienna, Austria.
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
Single-dose activated charcoal (SDAC) is frequently administered to poisoned patients. The assumption is that toxin absorption is prevented and that toxicity (as defined by morbidity and mortality) of the poisoning is decreased. Yet there is no evidence that SDAC improves outcome. Risks of this procedure have not been determined. The reported adverse events following SDAC administration are reviewed and risk:benefit ratio for this procedure is discussed.
Collapse
Affiliation(s)
- Donna Seger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4632, USA.
| |
Collapse
|
15
|
Hwang CF, Foot CL, Eddie G, Johnson L, Reith DM. The utility of the history and clinical signs of poisoning in childhood: a prospective study. Ther Drug Monit 2004; 25:728-34. [PMID: 14639060 DOI: 10.1097/00007691-200312000-00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors aimed to evaluate the utility of the history and clinical signs for predicting ingestion of poisons in children. A prospective cohort study was performed of all patients presenting with suspected poisoning to a pediatric emergency department over a 13-month period. Clinical data were collected on a preformatted consultation sheet. Urine drug screens (UDS) were analyzed by gas chromatography/mass spectrometry (GC/MS). Serum toxicologic tests were performed when clinically indicated. The sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the history and clinical signs were calculated, first using UDS and, second, using all available toxicologic tests as the gold standards. Of 249 patients, 110 (46%) had a UDS performed. The purported poison ingested was potentially identifiable by GC/MS in 57 (52%) of these UDS. Only the results from these 57 UDS were included in our statistical analysis. Overall, the suspected poison was identified in 33 (58%) of the 57 UDS. Similarly, in the less than 5 years age subgroup, 28 (56%) of 50 UDS were positive. Odor on the breath (PPV 100%), followed by symptoms consistent with poisoning (PPV 92%) and presence of poison on clothes (PPV 86%) were the most useful predictors of a positive UDS. Similar results were obtained when all available toxicologic tests were used as the gold standard. The best clinical predictors of poisonous ingestion in children were found to be odor on the breath, symptoms consistent with poisoning, and presence of poison on the patient's clothes. Approximately 40% of children who present with poisoning have not been exposed to the putative toxin.
Collapse
Affiliation(s)
- Caroline F Hwang
- Emergency Medicine, Mater Children's Hospital, South Brisbane, Queensland, Australia
| | | | | | | | | |
Collapse
|
16
|
Donoso A, Linares M, León J, Rojas G, Valverde C, Ramírez M, Oberpaur B. Activated charcoal laryngitis in an intubated patient. Pediatr Emerg Care 2003; 19:420-1. [PMID: 14676494 DOI: 10.1097/01.pec.0000101586.65509.d9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Activated charcoal is useful in the management of poisonings, but it is not harmless. We report the case of a patient who developed obstructive laryngitis secondary to aspiration of activated charcoal with a protected airway. CASE A 2-year-old girl presented acute mental alteration secondary to presumed poisoning. Mechanical ventilation was initiated, and a single dose of activated charcoal was administered. She had an episode of vomiting during the respiratory weaning. Black-tinted tracheal secretions were suctioned through the tube immediately. Pulmonary auscultation and radiologic examination were normal. When she was extubed, she developed obstructive laryngitis. Fiberbronchoscopy was performed and showed edema and a significant amount of charcoal particles on the epiglottis, arytenoids, and arytenoepiglottic folds. Charcoal particles were removed by bronchoscopy successfully. Later evolution was normal, and no symptoms were present when she was discharged at home. COMMENTS Obstructive laryngitis is a new major complication of activated charcoals use in upper airway. It is remarkable that this complication occurred in a protected airway. Charcoal is not an innocuous agent. This case shows that nasogastric administration of activated charcoals presents a significant degree of risk.
Collapse
Affiliation(s)
- Alejandro Donoso
- Pediatric Critical Care Area, Padre Hurtado Hospital, Santiago, Chile, South América.
| | | | | | | | | | | | | |
Collapse
|