Chapter 57: Poisonings and Intoxications

INTRODUCTION

To underscore the importance of poisoning in modern times recent statistics reveal that the annual deaths from poisoning (47,055 in 2014) now exceed those from traffic accidents in the United States (Figure 57–1). Opioid deaths in the United States, 18,893 in 2014, (Figure 57–2) and Europe (Table 57–1) have become so serious that the antidote naloxone in the form of nasal sprays are carried by police, emergency medical services, firemen, friends, and acquaintances for emergency treatment in the event of an overdose. On the other hand, in patients obtaining advice from their local poison control center mortality is low. The latest report of the American Association of Poison Control Centers (AAPCC) for 2014 reports experience with 2,165,142 human exposures. In 2014, the majority of cases (68.1%) were managed at home, 28.3% required treatment in a health care setting and 1408 patients died; 44,713 patients were treated with single dose activated charcoal; 11,275 were treated by alkalinization; 2481 received hemodialysis; 43 received hemoperfusion; 42 received extracorporeal oxygenation, 33 “other” extracorporeal treatment and 16 had an organ transplant.

MULTIPLE-DOSE ACTIVATED CHARCOAL

One method of removing ingested toxins from the body is administration of single or multiple doses of activated charcoal per os. Charcoal given acutely decreases absorption of toxins from the gastrointestinal tract but has also been recommended in repeated doses, to capture toxic substances from the enterohepatic recirculation. However, although there is some experimental evidence that this mode of therapy can decrease the half-life of many xenobiotics, there are only a few toxic substances for which multidose charcoal administration has been shown to be effective. According to the American Academy of Clinical Toxicology, these include carbamazepine, dapsone, phenobarbital, quinine, and theophylline. One recent study in volunteers suggests that repeated doses of superactivated charcoal may have some detoxification benefit up to 3 hours after acetaminophen ingestion. However, two other volunteer studies conclude that multiple-dose activated charcoal may not be effective more than 1 hour after acetaminophen overdose. Multiple-dose activated charcoal has also been reported to reduce death and serious arrhythmias in yellow oleander poisoning (Table 57–1).

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