Single-dose activated charcoal as a pre-hospital treatment for self-poisoning

This article aims to find and evaluate current available evidence to determine whether the known clinical benefits of orally administered single dose activated charcoal would justify its use in a pre-hospital ambulance setting. A search of medical databases resulted in evaluation of four studies considered to be of sufficient quality to answer the clinical question. The article acknowledges that further research is desirable into the long-term benefits of pre-hospital charcoal and that much current evidence relies on a reasonable extrapolation of benefit from toxin biomarker data in clinical trials. Nevertheless, it recommends that sufficient evidence now exists for ambulance services to consider its use in cases of self-poisoning attended by ambulance paramedics within one hour of toxin ingestion as recommended by NICE (2004) Clinical Practice Guideline Number 16: Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. Recent recommendations lowering the threshold of hepatotoxicity requiring hospital admission to 75 mg paracetamol per kg bodyweight (National Poisons Information Service, 2012) will undoubtedly increase the number of overdoses of the drug encountered by crews where charcoal may prove of benefit.

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