ABSTRACT
OBJECTIVE: To test the hypothesis that administration of activated charcoal is as efficacious and safe as the combination regimen of gastric emptying plus charcoal in adults after acute oral overdose. DESIGN: Prospective randomised controlled trial, with subjects presenting on odd-numbered dates allocated to the emptied group (E), and those on even-numbered dates to the not-emptied group (NE). SETTING: Princess Alexandra Hospital, Brisbane (a tertiary referral hospital), which serves an adult urban community, between 4 January 1988 and 11 June 1990. SUBJECTS: Consecutive patients (13 years or older) who presented to the Emergency Department after ingesting an overdose of one or more compounds able to be adsorbed by activated charcoal. INTERVENTIONS: All patients received charcoal by the oral or nasogastric route. Those in the E group also had gastric emptying by ipecac-induced emesis or gastric lavage. OUTCOME MEASURES: Clinical course during the first six hours after treatment began, length of hospital stay, complications. RESULTS: 876 patients were eligible for the study. There were no significant differences between the E and NE groups in age and sex distribution, severity of the overdose or other characteristics, except the mean interval between presentation and administration of charcoal (91 min [SD, 52] for E group and 55 [SD, 41] for NE group; P = 0.0001). There were no significant differences between the E and NE groups in outcome, even when the groups were stratified for severity of the overdose or into subgroups that presented sooner or later than one hour after ingestion. CONCLUSIONS: Gastric emptying can be omitted from the treatment protocol for adults after acute oral overdose.
Subject(s)
Charcoal/therapeutic use , Drug Overdose/therapy , Gastric Lavage , Ipecac/therapeutic use , Adolescent , Adult , Combined Modality Therapy , Drug Overdose/complications , Female , Humans , Length of Stay , Male , Prospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
A one-year prospective survey of serious hypoglycaemia has been carried out in the Wollongong area. Of insulin-treated patients attending the diabetes clinic, 3.5% had a hypoglycaemic attack of sufficient severity to be referred to hospital. A further 1% received treatment for attacks of hypoglycaemia at home. It is considered that nearly two-thirds of the attacks of hypoglycaemia may have been preventable. Further reductions may be achieved by the better education of patients about their disease.
