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Abstract
The management of acute poisoning remains an important part of accident and emergency care. Several gastric decontamination procedures have been widely used and their role has recently been reviewed and position statements developed by working groups of the American Academy of Clinical Toxicology and the European Association of Poisons Centers and Clinical Toxicologists. The main strategies of caring for patients who have swallowed poisons or been given an overdose of drugs, are inhibition of absorption (in acute poisoning after oral ingestion), or specific treatment if available and enhancement of drug elimination from the body.
Nowadays, activated charcoal is a useful adsorbent for gastric decontamination. Enhancement of elimination may involve multiple dosing of activated charcoal, hemodialysis, or charcoal hemoperfusion. In addition, gastrointestinal decontamination has been practiced for hundreds of years; however, only in the past few years have data emerged that only some patients demonstrate a clinical benefit. Because most potentially toxic ingestions involve agents that are not toxic in the quantity consumed, the exact circumstances in which decontamination is beneficial and which methods are most beneficial in those circumstances remain important topics of research.
Although many studies m animal and volunteers have demonstrated that multiple doses of activated charcoal increase drug elimination significantly, this therapy has not yet been shown, m a controlled study in poisoned patients, to reduce morbidity and mortality. Further studies are required to establish its role and the optimal dosage regimen of charcoal to be administered and demonstrate its clinical benefits The aim of this study is to determine the rational use of Multiple Dose Activated Charcoal, (MDAC), in poisoning centers, and to study the efficacy of Multiple Dose Activated Charcoal as enhanced elimination modalitv in different acute toxicities depending on Pharmacokinetics principals.
Forty four adult patients (36 females and 8 males) were selected from those admitted to Poison Control Center, (PCC). Patient’s ages ranged between 15 to 54 years. Candidates of this study included patients with acute intoxication by a drug to which MDAC is one of the routine enhanced elimination procedures at the PCe.
Patients were classified into 5 groups according to the type of drug ingested. Group (1): Theophylline; this group consisted of twelve patients, with age-range between 15 to 54 years. All cases in this group were females. Group (2): Paracetamol group, consisted of six patients, v,rith age range between 17 to 33 years. Five of them were females and one male. Group (3): Carbamazepine, which consisted of nine patients, their ages ranged between 16 to 44 years. They were five females and four males. Group (4): Salicylates, which consisted of eleven patients, with ages ranged between 16 to 32 years. Nine of them were female and two males. Group (5): Valproic acid; this group consisted of six patients; their ages ranged between 17 to 32 years. They were five females and one male.